Provider Demographics
NPI:1770500563
Name:KENNETH V. MASTER, M.D., P.C.
Entity Type:Organization
Organization Name:KENNETH V. MASTER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-310-0042
Mailing Address - Street 1:2 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1294
Mailing Address - Country:US
Mailing Address - Phone:856-310-0042
Mailing Address - Fax:
Practice Address - Street 1:2 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1294
Practice Address - Country:US
Practice Address - Phone:856-310-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty