1265407498 NPI number — DR. KEVIN CHRISTOPHER KEARNEY MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265407498 NPI number — DR. KEVIN CHRISTOPHER KEARNEY MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KEARNEY

Provider First Name:

KEVIN

Provider Middle Name:

CHRISTOPHER

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1265407498

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/06/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

100 E CARROLL ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SALISBURY

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21801-5422

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-546-6400

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

201 HALL HWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CRISFIELD

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21817-1237

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-968-1801

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

02/21/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  D17029 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 303940 . This is a "COVENTRY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 41596605 . This is a "CAREFIRST BC/BS RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 735687 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 521116591 . This is a "MARYLAND PHYSICIANS CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 1417210 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 3100658 . This is a "OPTIMUM CHPICE/MDIPA/MAMS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 031198 . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 521116591 . This is a "INFORMED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 784381000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 4459514 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 521116591 . This is a "TRICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: T5880027 . This is a "CF BC/BS GRP/GHMSI/BL CHO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".