MEDICARE: DR. JAMES C. KISKADDON 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	207W00000X	Ophthalmology Physician	MD017182E	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1396725537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES C. KISKADDON M.D.

Provider Business Mailing Address
First Line	:	144 S 8TH ST
Second Line	:	SUITE 110
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-2755
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 S 8TH ST
Second Line	:	SUITE 110
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-2755
Country	:	US
Telephone Number	:	717-263-9849
Fax Number	:	717-263-2705

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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