Provider Demographics
NPI:1164496733
Name:CAREY, KEVIN VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:VINCENT
Last Name:CAREY
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020642E207RG0100X
NY143022-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006856910001Medicaid
PAGU039897OtherMEDICARE GROUP
PA100014269OtherRR MEDICARE PIN
NY00365068Medicaid
PACC9269OtherRR MEDICARE GROUP
PA026459N9LMedicare ID - Type Unspecified
PA100014269OtherRR MEDICARE PIN
PAGU039897OtherMEDICARE GROUP