Healthcare Provider Details
I. General information
NPI: 1750479424
Provider Name (Legal Business Name): SCOTT L KIEHLMEIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 10/10/2006
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3 COOPER PLZ SUITE 200
CAMDEN NJ
08103-1438
US
IV. Provider business mailing address
3 COOPER PLZ SUITE 200
CAMDEN NJ
08103-1438
US
V. Phone/Fax
- Phone: 856-342-2472
- Fax: 856-968-8414
- Phone: 856-342-2472
- Fax: 856-968-8414
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | MA076047 |
| License Number State | NJ |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 1537778 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | PENNSYLVANIA BLUE SHIELD |
| # 2 | |
| Identifier | 2222443000 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AMERIHEALTH HMO |
| # 3 | |
| Identifier | 1107989 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AENTA US -HEALTHCARE |
| # 4 | |
| Identifier | 1537778 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AMERIHEALTH PPO |
| # 5 | |
| Identifier | 1107996 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AETNA US -HEALTHCARE |
| # 6 | |
| Identifier | 36940 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | UNIVERSITY HEALTH PLAN |
| # 7 | |
| Identifier | 0024929 |
| Identifier Type | MEDICAID |
| Identifier State | NJ |
| Identifier Issuer | |
| # 8 | |
| Identifier | 1932424 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | UNITED HEALTH CARE |
| # 9 | |
| Identifier | 2248846 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | CIGNA |
| # 10 | |
| Identifier | 010007777 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AMERICHOICE |
| # 11 | |
| Identifier | 1107968 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AETNA US-HEALTH CARE |
| # 12 | |
| Identifier | 60023286 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | HORIZON NJ HEALTH |
| # 13 | |
| Identifier | 7741574/1774288 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | AETNA US HEALTHCARE |
| # 14 | |
| Identifier | 3K6024 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | HEALTHNET, INC |
| # 15 | |
| Identifier | P3667478 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | OXFORD HEALTH PLAN D |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
