Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS014338 | PA |
N | 207Q00000X | Family Doctor | OT011732 | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | OS014338 | PA |
NPI | 1104913680 |
---|---|
Provider Name | Dr. Eric M Kephart |
First Address | Glen Allen, VA 23060-9263 |
Second Address | Fairless Hills, PA 19030-1008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 30/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1022699560002 | (05) | PA |