Provider Demographics
NPI:1912095647
Name:KASAMA, RICHARD K (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:KASAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:401 HADDON AVE RM 283
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1505
Mailing Address - Country:US
Mailing Address - Phone:856-757-7844
Mailing Address - Fax:856-757-7778
Practice Address - Street 1:1030 KINGS HWY N
Practice Address - Street 2:SUITE 310
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1907
Practice Address - Country:US
Practice Address - Phone:856-667-7266
Practice Address - Fax:856-779-9179
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA56250207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87156Medicare UPIN