Provider Demographics
NPI:1013210517
Name:KENT SEITZ MD PA
Entity Type:Organization
Organization Name:KENT SEITZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-844-0181
Mailing Address - Street 1:1421 ORCHARD LAKE DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-9998
Mailing Address - Country:US
Mailing Address - Phone:704-844-0181
Mailing Address - Fax:904-701-6279
Practice Address - Street 1:1421 ORCHARD LAKE DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-9998
Practice Address - Country:US
Practice Address - Phone:704-844-0181
Practice Address - Fax:904-701-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914829Medicaid
NC5914829Medicaid