MEDICARE: KRISTEN KUCHARCZUK MD

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	208000000X	Pediatrics Physician	MD071340L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053504787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN KUCHARCZUK MD

Provider Business Mailing Address
First Line	:	402 LIPPINCOTT DR
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4112
Country	:	US
Telephone Number	:	856-782-3300
Fax Number	:	856-504-8029

Provider Business Practice Location Address
First Line	:	701 MONTGOMERY AVE
Second Line	:	SUITE 18
City	:	PENN VALLEY
State	:	PA
Zip	:	19072-2036
Country	:	US
Telephone Number	:	610-642-9200
Fax Number	:	610-649-4723

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/02/2012

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