Provider Demographics
NPI:1174267132
Name:TAM, KEVIN ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALEXANDER
Last Name:TAM
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 1:101 MANNING DRIVE
Mailing Address - Street 2:OLD CLINIC BUILDING 3020 CAMPUS BOX# 7570
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7525
Mailing Address - Country:US
Mailing Address - Phone:919-966-4150
Mailing Address - Fax:919-984-9952
Practice Address - Street 1:101 MANNING DRIVE
Practice Address - Street 2:OLD CLINIC BUILDING 3020 CAMPUS BOX# 7570
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7525
Practice Address - Country:US
Practice Address - Phone:919-966-4150
Practice Address - Fax:919-984-9952
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRTL22-0095390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program