Provider Demographics
NPI:1063688661
Name:PRICE, KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 50520
Mailing Address - Street 2:DEPT. OF EMERGENCY MEDICINE
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-0520
Mailing Address - Country:US
Mailing Address - Phone:843-552-4240
Mailing Address - Fax:843-552-4121
Practice Address - Street 1:1101 BOWMAN ROAD
Practice Address - Street 2:DEPT. OF EMERGENCY MEDICINE
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3213
Practice Address - Country:US
Practice Address - Phone:843-552-4240
Practice Address - Fax:843-552-4121
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC33346207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC333464Medicaid