Healthcare Provider Details

I. General information

NPI: 1174889687
Provider Name (Legal Business Name): CASEY JOHN KISER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 GOOD HOPE RD
ENOLA PA
17025-1233
US

IV. Provider business mailing address

1830 GOOD HOPE RD
ENOLA PA
17025-1233
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-8135
  • Fax: 717-221-5600
Mailing address:
  • Phone: 717-988-8135
  • Fax: 717-221-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR7790
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD456095
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: