Healthcare Provider Details

I. General information

NPI: 1164496642
Provider Name (Legal Business Name): DAVID LEE KERSTETTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 HOSPITAL DR SUITE 1
EVERETT PA
15537-7018
US

IV. Provider business mailing address

185 HOSPITAL DR SUITE 1
EVERETT PA
15537-7018
US

V. Phone/Fax

Practice location:
  • Phone: 814-623-9039
  • Fax:
Mailing address:
  • Phone: 814-623-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD019479E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: