Provider Demographics
NPI:1447219860
Name:KEMBERLING, JOHN GARY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GARY
Last Name:KEMBERLING
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:CREDENTIALS DEPT
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:201 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-7969
Practice Address - Country:US
Practice Address - Phone:570-374-0151
Practice Address - Fax:570-374-0311
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007226L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001250250Medicaid
PA001250250Medicaid
PA680083Medicare ID - Type Unspecified