Provider Demographics
NPI:1659334357
Name:DEWITT E. KEMP III, MD, LLC
Entity Type:Organization
Organization Name:DEWITT E. KEMP III, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEWITT
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-467-6074
Mailing Address - Street 1:609 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1330
Mailing Address - Country:US
Mailing Address - Phone:814-467-6074
Mailing Address - Fax:814-467-0014
Practice Address - Street 1:609 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1330
Practice Address - Country:US
Practice Address - Phone:814-467-6074
Practice Address - Fax:814-467-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029007E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA413105OtherHIGHMARK
PA000912332001Medicaid
PAC33651Medicare UPIN
PA000912332001Medicaid