Provider Demographics
NPI:1740402064
Name:KEVIN FLEMING MD PC
Entity Type:Organization
Organization Name:KEVIN FLEMING MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-547-7126
Mailing Address - Street 1:710 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035
Mailing Address - Country:US
Mailing Address - Phone:856-547-7126
Mailing Address - Fax:856-547-4669
Practice Address - Street 1:710 STATION AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035
Practice Address - Country:US
Practice Address - Phone:856-547-7126
Practice Address - Fax:856-547-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46720207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081598Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER