Provider Demographics
NPI:1194773580
Name:NAFZIGER, KENNETH (M D)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:NAFZIGER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 STONEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-9601
Practice Address - Country:US
Practice Address - Phone:717-786-1202
Practice Address - Fax:717-786-7758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 026756 E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA 1184762Medicaid
PAMD 026756 EOtherMEDICAL LICENSE
PAMD 026756 EOtherMEDICAL LICENSE
PAMA 1184762Medicaid
PANA 108642Medicare ID - Type UnspecifiedMEDICARE