Provider Demographics
NPI:1003884891
Name:KIENZLE, RAND E (MD)
Entity Type:Individual
Prefix:
First Name:RAND
Middle Name:E
Last Name:KIENZLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 INDUSTRIAL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1620
Mailing Address - Country:US
Mailing Address - Phone:610-647-1484
Mailing Address - Fax:610-647-7068
Practice Address - Street 1:11 INDUSTRIAL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-647-1484
Practice Address - Fax:610-647-7068
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-053720-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G11152Medicare ID - Type Unspecified
PA789988Medicare ID - Type Unspecified