Provider Demographics
NPI:1306840343
Name:MCGRATH, KEVIN PETER (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PETER
Last Name:MCGRATH
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 1:912 SILAS DEANE HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3434
Mailing Address - Country:US
Mailing Address - Phone:203-255-9155
Mailing Address - Fax:860-257-0551
Practice Address - Street 1:912 SILAS DEANE HWY STE 100
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3497
Practice Address - Country:US
Practice Address - Phone:860-257-3535
Practice Address - Fax:860-257-0551
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027965207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V0206OtherHEALTHNET/ACS
CT010027965CT01OtherBCBS
CT030000081Medicare ID - Type Unspecified
E32412Medicare UPIN
CT0V0206OtherHEALTHNET/ACS