Provider Demographics
NPI:1053383596
Name:WENTLAND, KEVIN BARRY (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BARRY
Last Name:WENTLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:K
Other - Middle Name:BARRY
Other - Last Name:WENTLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2782 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8850
Mailing Address - Country:US
Mailing Address - Phone:717-741-2747
Mailing Address - Fax:
Practice Address - Street 1:3130 GRANDVIEW RD BLDG A
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-9134
Practice Address - Country:US
Practice Address - Phone:717-316-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006658L207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001198857Medicaid
PAP00043881Medicare PIN
PA609951N84Medicare ID - Type Unspecified
PA001198857Medicaid