MEDICARE: DR. WILLIAM KING JR. 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	207V00000X	Obstetrics & Gynecology Physician	MD034805E	PA
2	208D00000X	General Practice Physician	MD034805E	PA

General Provider Information

NPI Number	:	1457411670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM KING JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 18463
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21237-0463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 EAST ALLEGHENY AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134
Country	:	US
Telephone Number	:	215-834-9961
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	05/04/2008

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