Provider Demographics
NPI:1932333648
Name:KEDDIS, ROBERT N (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:KEDDIS
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 1:200 TRENTON RAOD
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015
Mailing Address - Country:US
Mailing Address - Phone:609-893-6611
Mailing Address - Fax:
Practice Address - Street 1:200 TRENTON RAOD
Practice Address - Street 2:FLOOR 1
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015
Practice Address - Country:US
Practice Address - Phone:609-893-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA09248300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ305140OtherMEDICARE
NJ0359378Medicaid