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NPI Code Detail

MEDICARE: DR. DALE C. KEPHART M.D.

MEDICARE: DR. DALE C. KEPHART M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianMD418345PA

General Provider Information

NPI Number : 1033178389
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DALE C. KEPHART M.D.
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-3034
Country : US
Telephone Number : 570-271-6144
Fax Number : 570-271-6578
Provider Business Practice Location Address
First Line : 21 GEISINGER LN
Second Line :
City : LEWISTOWN
State : PA
Zip : 17044-3400
Country : US
Telephone Number : 717-242-4200
Fax Number : 717-242-4212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 07/08/2007

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