Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS006658L | PA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OS006658L | PA |
NPI | 1053383596 |
---|---|
Provider Name | Dr. Kevin Barry Wentland |
First Address | York, PA 17402-8850 |
Second Address | Hanover, PA 17331-9134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 01/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001198857 | (05) | PA |