Individual
JONATHAN KEPPELE HETZEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
413 LONGWOOD DR, EXTON, PA 19341-1719
(610) 363-8260
(610) 363-8002
Mailing address
413 LONGWOOD DR, EXTON, PA 19341-1719
(610) 363-8260
(610) 363-8002
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD018132E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000064046
BLUE SHIELD
PA
01
—
2026826001
INDEPENDENCE BLUE CROSS
PA
Enumeration date
01/23/2006
Last updated
07/10/2012
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