Provider Demographics
NPI:1497246870
Name:DAVID, KEVIN CARL
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CARL
Last Name:DAVID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OHIO UNIVERSITY
Mailing Address - Street 2:PORTER HALL 200
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:916-342-3019
Mailing Address - Fax:
Practice Address - Street 1:OHIO UNIVERSITY
Practice Address - Street 2:PORTER HALL 200
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:916-342-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program