Provider Demographics
NPI:1902860646
Name:COLMER, KENNETH P (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:P
Last Name:COLMER
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 1:49 CARRIAGE LANE
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02675
Mailing Address - Country:US
Mailing Address - Phone:508-362-1357
Mailing Address - Fax:
Practice Address - Street 1:237 STATION AVE
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664
Practice Address - Country:US
Practice Address - Phone:508-394-2116
Practice Address - Fax:508-760-1919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60273208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3065855Medicaid
MAJ09937OtherBLUE CROSS BLUE SHIELD
MA3065855Medicaid