Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS029616L | PA |
N | 204E00000X | Oral & Maxillofacial Surgeon | MD073230L | PA |
NPI | 1154379873 |
---|---|
Provider Name | Dr. Gregory F Kewitt |
First Address | Pine Grove Mills, PA 16868-0626 |
Second Address | State College, PA 16801-7668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H70326 | (02) | PA |
KE1304618 | HIGHMARK BLUE SHIELD (01) | PA |