Healthcare Provider Details

I. General information

NPI: 1710994231
Provider Name (Legal Business Name): KETAN G KULKARNI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HARRISBURG PIKE STE 202
LANCASTER PA
17601
US

IV. Provider business mailing address

2112 HARRISBURG PIKE STE 212
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-869-4600
  • Fax: 717-544-3501
Mailing address:
  • Phone: 717-869-4600
  • Fax: 717-544-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD436316
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: