Provider Demographics
NPI:1417911652
Name:KNAPP, KIEREN PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:KIEREN
Middle Name:PATRICK
Last Name:KNAPP
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 1:55 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACOBUS
Mailing Address - State:PA
Mailing Address - Zip Code:17407-1248
Mailing Address - Country:US
Mailing Address - Phone:717-428-1911
Mailing Address - Fax:717-428-2519
Practice Address - Street 1:55 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JACOBUS
Practice Address - State:PA
Practice Address - Zip Code:17407-1248
Practice Address - Country:US
Practice Address - Phone:717-428-1911
Practice Address - Fax:717-428-2519
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-OO4435-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006577120001Medicaid
PA0006577120001Medicaid
KN152886Medicare ID - Type Unspecified