Healthcare Provider Details

I. General information

NPI: 1780671768
Provider Name (Legal Business Name): KUNKEL SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 POPLAR CHURCH RD SUITE 210
CAMP HILL PA
17011-2250
US

IV. Provider business mailing address

890 POPLAR CHURCH RD SUITE 210
CAMP HILL PA
17011-2250
US

V. Phone/Fax

Practice location:
  • Phone: 717-761-7244
  • Fax: 717-761-2055
Mailing address:
  • Phone: 717-761-7244
  • Fax: 717-761-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN A ROSSI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 717-761-7244