Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD-053720-L | PA |
NPI | 1003884891 |
---|---|
Provider Name | Rand E Kienzle |
First Address | Paoli, PA 19301-1620 |
Second Address | Paoli, PA 19301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 23/08/2018 |