Provider Demographics
NPI:1760461024
Name:NORTON, KEVIN P (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:NORTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2411
Mailing Address - Country:US
Mailing Address - Phone:856-779-7386
Mailing Address - Fax:856-773-7563
Practice Address - Street 1:19 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2411
Practice Address - Country:US
Practice Address - Phone:856-779-7386
Practice Address - Fax:856-773-7563
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07762000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0040771Medicaid
NJ0040771Medicaid