Provider Demographics
NPI:1023067741
Name:CHILDS, KATHRYN P (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:P
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:33 N FULLERTON AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3412
Mailing Address - Country:US
Mailing Address - Phone:973-509-6039
Mailing Address - Fax:
Practice Address - Street 1:33 N FULLERTON AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3412
Practice Address - Country:US
Practice Address - Phone:973-509-6039
Practice Address - Fax:973-509-6069
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07491800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG16083Medicare UPIN
NJ076256MCYMedicare ID - Type Unspecified