Provider Demographics
NPI:1689024648
Name:KEMMLER, CHARLES (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:KEMMLER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SPRUCE STREET
Mailing Address - Street 2:PINE BASEMENT WEST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4022
Mailing Address - Country:US
Mailing Address - Phone:303-921-1175
Mailing Address - Fax:
Practice Address - Street 1:700 SPRUCE STREET
Practice Address - Street 2:PINE BASEMENT WEST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4022
Practice Address - Country:US
Practice Address - Phone:303-921-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84659207P00000X
PAMT212053207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC846598Medicaid