Healthcare Provider Details

I. General information

NPI: 1942002431
Provider Name (Legal Business Name): KYLE KIDD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KYLE-ALLEN KIDD

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

110 POST OFFICE RD
SWEET VALLEY PA
18656-2319
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6203
  • Fax: 570-271-5976
Mailing address:
  • Phone: 570-690-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: