Provider Demographics
NPI:1285715177
Name:JOSEPH E. KEPKO D.O., P.C.
Entity type:Organization
Organization Name:JOSEPH E. KEPKO D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEPKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-638-4340
Mailing Address - Street 1:5000 BENSALEM BLVD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4043
Mailing Address - Country:US
Mailing Address - Phone:215-638-4340
Mailing Address - Fax:
Practice Address - Street 1:5000 BENSALEM BLVD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4043
Practice Address - Country:US
Practice Address - Phone:215-638-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1687874OtherBLUE SHIELD
PAF70885Medicare UPIN
PA1687874OtherBLUE SHIELD
PA134883Medicare PIN