Healthcare Provider Details

I. General information

NPI: 1801895214
Provider Name (Legal Business Name): KIMBERLY ANN SLUSSER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 W NEWPORT RD
LITITZ PA
17543-7774
US

IV. Provider business mailing address

6 W NEWPORT RD
LITITZ PA
17543-7774
US

V. Phone/Fax

Practice location:
  • Phone: 717-627-2108
  • Fax: 717-627-2434
Mailing address:
  • Phone: 717-627-2108
  • Fax: 717-627-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23792
License Number StateOK

VII. Legacy identifiers

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

# 1
Identifier200038960A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: