Provider Demographics
NPI:1275571564
Name:MCCANN, KEVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:MCCANN
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5890
Mailing Address - Fax:740-446-5532
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5890
Practice Address - Fax:740-446-5532
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0552172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1275571564OtherNPI
WV3810001649Medicaid
OH000000190735OtherUNISON MEDICAID
P00203692OtherRR MEDICARE
000000359015OtherANTHEM BCBS
OH2545982OtherMOLINA MEDICAID
E19800Medicare UPIN
OH4155673Medicare PIN
P00203692OtherRR MEDICARE
WV4155674Medicare PIN