Healthcare Provider Details

I. General information

NPI: 1952567943
Provider Name (Legal Business Name): KENT ROBERT ZETTEL II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WALNUT ST STE 100
LEMOYNE PA
17043
US

IV. Provider business mailing address

409 S 2ND ST STE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-761-4141
  • Fax: 717-761-1456
Mailing address:
  • Phone: 717-761-4141
  • Fax: 717-761-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA139271
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD452164
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: