Provider Demographics
NPI:1659385615
Name:KINDSFATHER, SCOTT KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KENNETH
Last Name:KINDSFATHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 CAPITAL WAY
Mailing Address - Street 2:STE 220
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2523
Mailing Address - Country:US
Mailing Address - Phone:609-303-0747
Mailing Address - Fax:609-303-0771
Practice Address - Street 1:408 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4502
Practice Address - Country:US
Practice Address - Phone:609-396-5800
Practice Address - Fax:609-396-5528
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA56656207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1096898OtherHORIZON NJ HEALTH
NJ1462388OtherUNITED HC/RAILROAD MC
NJF17206OtherHNET
NJ0056735000OtherKEYSTONE
NJ222369868OtherHORIZON BC/BS OF NJ
NJ765518OtherAETNA
NJ1523708OtherUMWA
NJ7273100Medicaid
NJ0056735000OtherAMERIHEALTH
NJF17206OtherGHN
NJ023957BL1Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
NJF17206OtherHNET