Basic Information
| Provider Information | |||||||||
| NPI: | 1114378148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLUMMER | ||||||||
| FirstName: | KAITLIN | ||||||||
| MiddleName: | LOU | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ZEIGENFUSE | ||||||||
| OtherFirstName: | KAITLIN | ||||||||
| OtherMiddleName: | LOU | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7 DOCK HILL RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178428910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708372123 | ||||||||
| FaxNumber: | 5708372185 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 N FRONT ST | ||||||||
| Address2: | |||||||||
| City: | STEELTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171132240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179394593 | ||||||||
| FaxNumber: | 7179390955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2016 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OT016953 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS018955 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 823261 | 01 | PA | MEDICARE | OTHER | 1033048170002 | 05 | PA | MEDICAID |