Healthcare Provider Details

I. General information

NPI: 1578017141
Provider Name (Legal Business Name): PAUL KEMMLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S CENTER AVE
SOMERSET PA
15501-2033
US

IV. Provider business mailing address

170 E ROSEVILLE RD
LANCASTER PA
17601-3853
US

V. Phone/Fax

Practice location:
  • Phone: 814-443-5000
  • Fax:
Mailing address:
  • Phone: 717-951-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberIN PROCESS
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: