MEDICARE: ANN M KING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD064126L	PA

General Provider Information

NPI Number	:	1871572560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN M KING M.D.

Provider Business Mailing Address
First Line	:	2850 WILLOW STREET PIKE N
Second Line	:	SUITE A
City	:	WILLOW STREET
State	:	PA
Zip	:	17584-9200
Country	:	US
Telephone Number	:	717-464-9430
Fax Number	:	717-464-1680

Provider Business Practice Location Address
First Line	:	2850 WILLOW STREET PIKE N
Second Line	:	SUITE A
City	:	WILLOW STREET
State	:	PA
Zip	:	17584-9200
Country	:	US
Telephone Number	:	717-464-9430
Fax Number	:	717-464-1680

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	09/13/2010

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