Provider Demographics
NPI:1154379873
Name:KEWITT, GREGORY F (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:F
Last Name:KEWITT
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 WINDMERE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7643
Mailing Address - Country:US
Mailing Address - Phone:814-235-7700
Mailing Address - Fax:814-235-7633
Practice Address - Street 1:474 WINDMERE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7668
Practice Address - Country:US
Practice Address - Phone:814-235-7700
Practice Address - Fax:814-235-7633
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073230L204E00000X, 2082S0099X
PADS029616L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE1304618OtherHIGHMARK BLUE SHIELD
PA062356QYIMedicare PIN
PAP0070434Medicare ID - Type UnspecifiedRAILROAD MEDICARE
PAH70326Medicare UPIN