Basic Information
| Provider Information | |||||||||
| NPI: | 1164449153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEDEM | ||||||||
| FirstName: | ROY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 S BRYN MAWR AVE | ||||||||
| Address2: | SUITE H321 | ||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843374097 | ||||||||
| FaxNumber: | 4843374082 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 E PARK AVE | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168036709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142784818 | ||||||||
| FaxNumber: | 8142346150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 03/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD431105 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD431105 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.