Provider Demographics
NPI:1326018755
Name:PHO, KEVIN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:Y
Last Name:PHO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:C/O ST MARY'S HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8695
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:173 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5224
Practice Address - Country:US
Practice Address - Phone:603-891-4400
Practice Address - Fax:603-891-4414
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH11673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074514Medicaid
NHH53349Medicare UPIN
NH30202283Medicaid