Provider Demographics
NPI:1578564738
Name:KEMP, JONATHAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:KEMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199471-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000086338OtherGHI HMO
000405012001OtherBLUE SHIELD NENY
10001037OtherCDPHP
CAN1994714OtherWORKERS COMP
000405012002OtherBLUE SHIELD
NY01561504Medicaid
040426006641OtherFIDELIS
05302OtherMVP
110160500OtherUS DEPT OF LABOR
6T854OtherEMPIRE BLUE CROSS
33570HOtherFIDELIS MEDICARE
9689400OtherGHI
199471-1OtherTRICARE
G09312OtherAMERICAN PROGRESSIVE TODA
JK06T85420OtherEMPIRE BLUE CROSS
JK06T85410OtherEMPIRE BLUE CROSS
CAN1994714OtherNO FAULT
G09312Medicare UPIN
050037884Medicare PIN
05302OtherMVP