Healthcare Provider Details

I. General information

NPI: 1164833612
Provider Name (Legal Business Name): JUSTIN KISTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2014
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TILLMAN DR FL 2
BENSALEM PA
19020-2071
US

IV. Provider business mailing address

1941 LIMESTONE RD STE 101
WILMINGTON DE
19808-5413
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-9999
  • Fax:
Mailing address:
  • Phone: 302-655-9494
  • Fax: 302-691-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMT206253
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC1-0013633
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD467596
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: