Healthcare Provider Details

I. General information

NPI: 1912981531
Provider Name (Legal Business Name): DEWITT E KEMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOMERSET AVE
WINDBER PA
15963-1331
US

IV. Provider business mailing address

600 SOMERSET AVE
WINDBER PA
15963-1331
US

V. Phone/Fax

Practice location:
  • Phone: 814-467-3653
  • Fax: 814-467-3655
Mailing address:
  • Phone: 814-467-3653
  • Fax: 814-467-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD029007E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier413105
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE CROSS
# 2
Identifier0009123320001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: