Provider Demographics
NPI:1104183649
Name:MCANINCH, KEVIN P (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:MCANINCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3555 OLENTANGY RIVER ROAD
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3984
Mailing Address - Country:US
Mailing Address - Phone:614-268-8134
Mailing Address - Fax:614-268-8406
Practice Address - Street 1:3555 OLENTANGY RIVER ROAD
Practice Address - Street 2:SUITE 1080
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3984
Practice Address - Country:US
Practice Address - Phone:614-268-8134
Practice Address - Fax:614-268-8406
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34.011598208M00000X
OH34011598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126696Medicaid
OHH386590Medicare PIN