Provider Demographics
NPI:1982154837
Name:MEDLEY, KARL WILLIAM SR (MED)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:WILLIAM
Last Name:MEDLEY
Suffix:SR
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 PLEASANT AVE.
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110
Mailing Address - Country:US
Mailing Address - Phone:856-580-5733
Mailing Address - Fax:856-225-7650
Practice Address - Street 1:330 FEDERAL ST.
Practice Address - Street 2:CAMDEN COUNTY DEPT. OF CORRECTIONS- SECOND CHANCE
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102
Practice Address - Country:US
Practice Address - Phone:856-580-5733
Practice Address - Fax:856-225-7650
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator