Provider Demographics
NPI:1093765950
Name:PLANCHER, KEVIN D (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:PLANCHER
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 1:1160 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1212
Mailing Address - Country:US
Mailing Address - Phone:212-876-5200
Mailing Address - Fax:212-876-4440
Practice Address - Street 1:1160 PARK AVE
Practice Address - Street 2:NEW YORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1212
Practice Address - Country:US
Practice Address - Phone:203-863-2003
Practice Address - Fax:203-863-2003
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030654207X00000X
NY181664207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY513G41Medicare PIN
CT5091060001Medicare NSC
CT200000864Medicare PIN
NY5114460001Medicare NSC
CTC02922Medicare PIN