Provider Demographics
NPI:1053421412
Name:KERR, ANGELA DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DENISE
Last Name:KERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WILLOUGHBY ST
Mailing Address - Street 2:3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5465
Mailing Address - Country:US
Mailing Address - Phone:718-250-8318
Mailing Address - Fax:718-797-5495
Practice Address - Street 1:240 WILLOUGHBY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5465
Practice Address - Country:US
Practice Address - Phone:718-250-8318
Practice Address - Fax:718-797-5495
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165697174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01031209Medicaid
NY02E421Medicare ID - Type Unspecified
NY01031209Medicaid