Basic Information
| Provider Information | |||||||||
| NPI: | 1174602478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINCEL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 RUNDLE ST | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185042908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702413816 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 COMMUNITY DR | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | TOBYHANNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184668985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708398754 | ||||||||
| FaxNumber: | 5708390893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 06/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA052803 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 111433PZP | 05 | PA | MEDICAID |