Basic Information
| Provider Information | |||||||||
| NPI: | 1952567943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZETTEL | ||||||||
| FirstName: | KENT | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 S 2ND ST STE 2F | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177614141 | ||||||||
| FaxNumber: | 7177611456 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 WALNUT ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177614141 | ||||||||
| FaxNumber: | 7177611456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2008 | ||||||||
| LastUpdateDate: | 01/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A139271 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD452164 | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | MT193041 | 01 | PA | MEDICAL TRAINING NUMBER | OTHER | A139271 | 01 | CA | CALIFORNIA MEDICAL LICENSE | OTHER | MD452164 | 01 | PA | PENNSYLVANIA LICENSE | OTHER |