Basic Information
Provider Information | |||||||||
NPI: | 1386693760 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KESTNER | ||||||||
FirstName: | JOSEPH | ||||||||
MiddleName: | F | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4745 OGLETOWN STANTON RD | ||||||||
Address2: | MAP 1, SUITE 220 | ||||||||
City: | NEWARK | ||||||||
State: | DE | ||||||||
PostalCode: | 197132067 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3023685515 | ||||||||
FaxNumber: | 3023661240 | ||||||||
Practice Location | |||||||||
Address1: | 4745 OGLETOWN STANTON RD | ||||||||
Address2: | MAP 1, SUITE 220 | ||||||||
City: | NEWARK | ||||||||
State: | DE | ||||||||
PostalCode: | 197132067 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3023685515 | ||||||||
FaxNumber: | 3023661240 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/10/2006 | ||||||||
LastUpdateDate: | 11/29/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | C10000749 | DE | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | 4284648 | 01 |   | AETNA/USHC | OTHER | 43869 | 01 |   | COVENTRY | OTHER | 52685902 | 01 | MD | CARE FIRST BCBS | OTHER | 0000050201 | 05 | DE |   | MEDICAID | 290723 | 01 |   | MAMSI | OTHER | 0081251000 | 01 |   | AMERIHEALTH/KEYSTONE | OTHER | 121181 | 01 |   | INDEPENDENCE BCBS | OTHER | 1067689001 | 01 |   | CIGNA | OTHER |