1619170214 NPI number — KYLE J. MESSICK MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619170214 NPI number — KYLE J. MESSICK MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MESSICK

Provider First Name:

KYLE

Provider Middle Name:

J.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1619170214

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/19/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1803 MOUNT ROSE AVE

Provider Second Line Business Mailing Address:

SUITE B3

Provider Business Mailing Address City Name:

YORK

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17403-3026

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

717-851-1405

Provider Business Mailing Address Fax Number:

717-339-2502

Provider First Line Business Practice Location Address:

18 DEATRICK DRIVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GETTYSBURG

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17325-6958

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-339-2500

Provider Business Practice Location Address Fax Number:

717-339-2502

Provider Enumeration Date:

06/09/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  MD433891 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207XS0114X , with the licence number: 0101241179 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 209955 . This is a "JOHNS HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1571814 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 50077882 . This is a "CAPITAL BLUE CROSS-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 037148300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 118477 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 102126720 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 243326 . This is a "UNISON-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0911193 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 20076180 . This is a "AMERIHEALTH MERCY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 929010-01 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 2038928 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".