Healthcare Provider Details

I. General information

NPI: 1134115082
Provider Name (Legal Business Name): KENNETH D TRUSCOTT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HAWK RIDGE DR
HAMBURG PA
19526-9219
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 610-562-3066
  • Fax: 610-562-3125
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD036683E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: