Provider Demographics
NPI:1144258617
Name:KRETCHMER, DONALD S (DPM)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:S
Last Name:KRETCHMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5442
Mailing Address - Country:US
Mailing Address - Phone:570-283-0220
Mailing Address - Fax:570-283-1707
Practice Address - Street 1:421 MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5442
Practice Address - Country:US
Practice Address - Phone:570-283-0220
Practice Address - Fax:570-283-1707
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-0023300-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0886617Medicaid
PA416204Medicare ID - Type Unspecified
PA0886617Medicaid