Provider Demographics
NPI:1447259023
Name:KIVITZ, ALAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:KIVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8445
Mailing Address - Country:US
Mailing Address - Phone:814-693-0300
Mailing Address - Fax:814-693-0400
Practice Address - Street 1:175 MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8445
Practice Address - Country:US
Practice Address - Phone:814-693-0300
Practice Address - Fax:814-693-0400
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD026744E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA338517OtherBLUE SHEILD
PA1007706880003Medicaid
PA1007706880003Medicaid
B34867Medicare UPIN