MEDICARE: DR. KENNETH V. WILLIAMS D.O.

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	OS-008437-L	PA

General Provider Information

NPI Number	:	1417911009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH V. WILLIAMS D.O.

Provider Business Mailing Address
First Line	:	6101 LIMEKILN PIKE
Second Line	:	MEDICAL SUITE
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-1423
Country	:	US
Telephone Number	:	215-548-2010
Fax Number	:	215-548-2130

Provider Business Practice Location Address
First Line	:	6101 LIMEKILN PIKE
Second Line	:	MEDICAL SUITE
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-1423
Country	:	US
Telephone Number	:	215-548-2010
Fax Number	:	215-548-2130

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	11/29/2021

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