Provider Demographics
NPI:1154450310
Name:MEYER, KEVIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:B
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:87 MCGREGOR ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3765
Mailing Address - Country:US
Mailing Address - Phone:603-695-2640
Mailing Address - Fax:603-695-2647
Practice Address - Street 1:87 MCGREGOR ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3765
Practice Address - Country:US
Practice Address - Phone:603-695-2640
Practice Address - Fax:603-695-2647
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226533207R00000X
NH14770207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8514010Medicaid
OR218619Medicaid