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NPI Code Detail

MEDICARE: DAVID ANDREW KELLENBERGER PA, RD

MEDICARE: DAVID ANDREW KELLENBERGER PA, RD
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
1363A00000XPhysician AssistantPA04525TX
2208M00000XHospitalist PhysicianPA9120088FL
3133V00000XRegistered DietitianDT81736TX
4363A00000XPhysician AssistantPA9120088FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11G0179OTHERTXMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073632410
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID ANDREW KELLENBERGER PA, RD
Provider Business Mailing Address
First Line : PO BOX 11126
Second Line :
City : BELFAST
State : ME
Zip : 04915-4002
Country : US
Telephone Number : 877-856-3774
Fax Number : 239-599-2612
Provider Business Practice Location Address
First Line : 2343 AARON ST
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33952-5305
Country : US
Telephone Number : 855-979-5700
Fax Number : 855-979-5701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 05/06/2026

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Directions to “ DAVID ANDREW KELLENBERGER PA, RD” Practice Location

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