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NPI Code Detail

MEDICARE: MARTHA JEAN KECK APN

MEDICARE: MARTHA JEAN KECK APN
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
1363LG0600XGerontology Nurse PractitionerNR49634NJ

Other Identifiers

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

General Provider Information

NPI Number : 1942255443
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA JEAN KECK APN
Provider Business Mailing Address
First Line : 5525 RESEARCH PARK DRIVE
Second Line : 4TH FLOOR
City : BALTIMORE
State : MD
Zip : 21228-4664
Country : US
Telephone Number : 973-831-3540
Fax Number : 973-831-3503
Provider Business Practice Location Address
First Line : 1 CEDAR CREST VILLAGE DR
Second Line :
City : POMPTON PLAINS
State : NJ
Zip : 07444-2100
Country : US
Telephone Number : 973-831-3540
Fax Number : 973-831-3503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 05/06/2015

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Directions to “ MARTHA JEAN KECK APN” Practice Location

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