Provider Demographics
NPI:1710994231
Name:KULKARNI, KETAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:KETAN
Middle Name:G
Last Name:KULKARNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2112 HARRISBURG PIKE STE 212
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-869-4600
Mailing Address - Fax:717-544-3501
Practice Address - Street 1:2112 HARRISBURG PIKE STE 202
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-869-4600
Practice Address - Fax:717-544-3501
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436316207RG0100X
NY235817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023671700002Medicaid
PA1023671700003Medicaid
PA1023671700004Medicaid