Provider Demographics
NPI:1952567943
Name:ZETTEL, KENT ROBERT II (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:ROBERT
Last Name:ZETTEL
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-761-4141
Mailing Address - Fax:717-761-1456
Practice Address - Street 1:3 WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043
Practice Address - Country:US
Practice Address - Phone:717-761-4141
Practice Address - Fax:717-761-1456
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139271208600000X
PAMD452164208600000X
PAMT193041390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT193041OtherMEDICAL TRAINING NUMBER
CAA139271OtherCALIFORNIA MEDICAL LICENSE
PAMD452164OtherPENNSYLVANIA LICENSE