Provider Demographics
NPI:1528645751
Name:PROWSE, KENDALL JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:JAMES
Last Name:PROWSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:
Other - Last Name:PROWSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:500 UNIVERSITY DRIVE MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:
Practice Address - Street 1:1135 OLDE W CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9188
Practice Address - Country:US
Practice Address - Phone:717-531-7010
Practice Address - Fax:717-531-7102
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS024942208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY64501Medicaid