Healthcare Provider Details

I. General information

NPI: 1841287844
Provider Name (Legal Business Name): CHARLES B. KRESPAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 GOOD DR SUITE 112
LANCASTER PA
17601-2433
US

IV. Provider business mailing address

694 GOOD DR SUITE 112
LANCASTER PA
17601-2433
US

V. Phone/Fax

Practice location:
  • Phone: 717-397-8177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD034753E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD034753E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: