Provider Demographics
NPI:1164522520
Name:BAN, KEVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:BAN
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 1:295 TAPPAN ST
Mailing Address - Street 2:UNIT #2
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-5308
Mailing Address - Country:US
Mailing Address - Phone:617-879-2516
Mailing Address - Fax:
Practice Address - Street 1:295 TAPPAN ST
Practice Address - Street 2:UNIT #2
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-5308
Practice Address - Country:US
Practice Address - Phone:617-879-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208677207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine