Provider Demographics
NPI:1326091190
Name:KNEIDINGER, HENRY JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOHN
Last Name:KNEIDINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 MARKLEY RD
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1924
Mailing Address - Country:US
Mailing Address - Phone:215-679-8783
Mailing Address - Fax:
Practice Address - Street 1:1454 MARKLEY RD
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-1924
Practice Address - Country:US
Practice Address - Phone:215-679-8783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003445L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD98700Medicare UPIN