Provider Demographics
NPI:1497100945
Name:LE, KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:601 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1445
Mailing Address - Country:US
Mailing Address - Phone:570-253-8226
Mailing Address - Fax:570-253-8228
Practice Address - Street 1:132 MANLY RD
Practice Address - Street 2:
Practice Address - City:TAFTON
Practice Address - State:PA
Practice Address - Zip Code:18464-7829
Practice Address - Country:US
Practice Address - Phone:570-226-2151
Practice Address - Fax:570-226-1861
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD467954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine