Provider Demographics
NPI:1558585497
Name:LAW, KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6481
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-0481
Mailing Address - Country:US
Mailing Address - Phone:609-586-7400
Mailing Address - Fax:609-586-7656
Practice Address - Street 1:2312 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1953
Practice Address - Country:US
Practice Address - Phone:608-586-7400
Practice Address - Fax:609-586-7656
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062504207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110202981OtherRAIL ROAD MEDICARE
NJ0K8149OtherPHS
NJ1110647OtherMERCY
NJ2046347OtherAETNA
NJ0683143000OtherAMERIHEALTH
NJ7092601Medicaid
NJ1110647OtherMERCY