Healthcare Provider Details

I. General information

NPI: 1598400392
Provider Name (Legal Business Name): KEPHARTSPORTSMEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 HYDE PARK
DOYLESTOWN PA
18902-6619
US

IV. Provider business mailing address

403 HYDE PARK
DOYLESTOWN PA
18902-6619
US

V. Phone/Fax

Practice location:
  • Phone: 267-406-4083
  • Fax: 267-406-4659
Mailing address:
  • Phone: 267-406-4083
  • Fax: 267-406-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC M KEPHART
Title or Position: OWNER
Credential: DO
Phone: 267-980-1864