Provider Demographics
NPI:1265443816
Name:EPSTEIN, KEVIN G (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:EPSTEIN
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 1:811 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN ORCHARD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1001
Mailing Address - Country:US
Mailing Address - Phone:413-439-0609
Mailing Address - Fax:413-439-0623
Practice Address - Street 1:811 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-1001
Practice Address - Country:US
Practice Address - Phone:413-439-0609
Practice Address - Fax:413-439-0623
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3153924Medicaid
A21433Medicare ID - Type Unspecified
MA3153924Medicaid