Provider Demographics
NPI:1982644852
Name:GUISTWITE, KENNETH R (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:GUISTWITE
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 1:522 S PITT ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3820
Mailing Address - Country:US
Mailing Address - Phone:717-243-1516
Mailing Address - Fax:717-243-4849
Practice Address - Street 1:522 S PITT ST
Practice Address - Street 2:GUISTWITE FAMILY PRACTICE
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3820
Practice Address - Country:US
Practice Address - Phone:717-243-1516
Practice Address - Fax:717-243-4849
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA014273E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
050013Medicare ID - Type Unspecified
PAB37276Medicare UPIN