Healthcare Provider Details

I. General information

NPI: 1598767519
Provider Name (Legal Business Name): DANIEL J. KERBACHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ROUTE 522
SELINSGROVE PA
17870-8707
US

IV. Provider business mailing address

436 E 11TH ST
BERWICK PA
18603-2228
US

V. Phone/Fax

Practice location:
  • Phone: 570-372-5690
  • Fax:
Mailing address:
  • Phone: 570-759-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD023726E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: