Active NPI
Paul A Kettl, M.D.
- Psychiatry Physician
- Lancaster, PA
National Provider Identifier
1124018254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD036495E
- Practice address
- 802 New Holland Ave
Lancaster, PA 17602-2163 - Phone
- (717) 560-3782
- Fax
- (717) 560-3787
- NPI assigned
- Oct 28, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD036495E | PA | Primary |
Addresses
Primary practice location
802 New Holland Ave
Lancaster, PA 17602-2163
Mailing address
802 New Holland Ave
Lancaster, PA 17602-2163
Phone (717) 560-3782
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50048776 | Other | PA | CAPITAL BLUE CROSS |
| 100774 | Other | PA | VALUE OPTIONS |
| 0010554330003 | Medicaid | PA | |
| 427936 | Other | PA | HIGHMARK BLUE SHIELD |
| 0010554330001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD036495E | PA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187481600000",
"number": "1124018254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "802 NEW HOLLAND AVE",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176022163",
"telephone_number": "717-560-3782",
"fax_number": "717-560-3787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 NEW HOLLAND AVE",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176022163",
"telephone_number": "717-560-3782",
"fax_number": "717-560-3787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTL",
"first_name": "PAUL",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-28",
"last_updated": "2007-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MD036495E",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50048776",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "100774",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0010554330003",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "427936",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0010554330001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.