Provider Demographics
NPI:1164496642
Name:KERSTETTER, DAVID LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:KERSTETTER
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 1:185 HOSPITAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7018
Mailing Address - Country:US
Mailing Address - Phone:814-623-9039
Mailing Address - Fax:
Practice Address - Street 1:185 HOSPITAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7018
Practice Address - Country:US
Practice Address - Phone:814-623-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019479E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000745664Medicaid
PAB39966Medicare UPIN
PA152988FEVMedicare ID - Type Unspecified