Individual
KEVIN KACZMAREK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
130 N 4TH ST, SUNBURY, PA 17801-2211
(570) 286-1482
(570) 286-5243
Mailing address
7 DOCK HILL RD, MIDDLEBURG, PA 17842-8910
(570) 837-2123
(570) 837-2185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA003203L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA003203L
LICENSE NUMBER
PA
Enumeration date
06/06/2006
Last updated
07/08/2007
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