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Individual

PAUL A KETTL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
802 NEW HOLLAND AVE, LANCASTER, PA 17602-2163
(717) 560-3782
(717) 560-3787
Mailing address
802 NEW HOLLAND AVE, LANCASTER, PA 17602-2163
(717) 560-3782
(717) 560-3787

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD036495E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0010554330001
PA
05
0010554330003
PA
01
100774
VALUE OPTIONS
PA
01
427936
HIGHMARK BLUE SHIELD
PA
01
50048776
CAPITAL BLUE CROSS
PA
Enumeration date
10/28/2005
Last updated
08/19/2007
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