Provider Demographics
NPI:1083717185
Name:HURTT, KEVIN GERARD (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:GERARD
Last Name:HURTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:STE 147
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6755
Mailing Address - Country:US
Mailing Address - Phone:301-698-5550
Mailing Address - Fax:301-698-1675
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:STE 147
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6755
Practice Address - Country:US
Practice Address - Phone:301-698-5550
Practice Address - Fax:301-698-1675
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041615208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F74671Medicare UPIN
378RMedicare ID - Type Unspecified