Provider Demographics
NPI:1871681353
Name:KERR, WILLIAM BLAKELEY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BLAKELEY
Last Name:KERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HAMPTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4973
Mailing Address - Country:US
Mailing Address - Phone:631-537-1892
Mailing Address - Fax:631-537-3053
Practice Address - Street 1:83 WAINSCOTT NORTHWEST RD
Practice Address - Street 2:
Practice Address - City:WAINSCOTT
Practice Address - State:NY
Practice Address - Zip Code:11975-2003
Practice Address - Country:US
Practice Address - Phone:631-537-1892
Practice Address - Fax:631-537-3053
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183802208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02491385Medicaid
NYA400002460Medicare PIN
NY02491385Medicaid