Healthcare Provider Details

I. General information

NPI: 1881055820
Provider Name (Legal Business Name): MATTHEW KERPER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HIGHLANDS DR
LITITZ PA
17543-7694
US

IV. Provider business mailing address

1500 HIGHLANDS DR
LITITZ PA
17543-7694
US

V. Phone/Fax

Practice location:
  • Phone: 717-231-8772
  • Fax: 717-231-8435
Mailing address:
  • Phone: 717-231-8772
  • Fax: 717-231-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT016920
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS019152
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: