Provider Demographics
NPI:1619170214
Name:MESSICK, KYLE J (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:MESSICK
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 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-339-2502
Practice Address - Street 1:18 DEATRICK DRIVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-6958
Practice Address - Country:US
Practice Address - Phone:717-339-2500
Practice Address - Fax:717-339-2502
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433891207X00000X
VA0101241179207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA209955OtherJOHNS HOPKINS
PA1571814OtherGATEWAY-WMG
PA50077882OtherCAPITAL BLUE CROSS-WMG
MD037148300Medicaid
PA118477OtherGEISINGER HEALTH PLAN
PA102126720Medicaid
PA243326OtherUNISON-WMG
PA0911193OtherAETNA
PA20076180OtherAMERIHEALTH MERCY-WMG
MD929010-01OtherCAREFIRST MD BCBS
PA2038928OtherHIGHMARK BLUE SHIELD
PA0911193OtherAETNA