Provider Demographics
NPI:1477643294
Name:CAREY, KEVIN JAMES (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:CAREY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RIVER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1137
Mailing Address - Country:US
Mailing Address - Phone:570-824-8151
Mailing Address - Fax:
Practice Address - Street 1:220 S RIVER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1137
Practice Address - Country:US
Practice Address - Phone:570-824-8151
Practice Address - Fax:570-824-0111
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009805L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G88048Medicare UPIN
PA024628Medicare Oscar/Certification