Provider Demographics
NPI:1497838742
Name:KEARNEY, KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:KEARNEY
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 1:1051 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5436
Mailing Address - Country:US
Mailing Address - Phone:843-522-7890
Mailing Address - Fax:843-522-7889
Practice Address - Street 1:1051 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5436
Practice Address - Country:US
Practice Address - Phone:843-522-7890
Practice Address - Fax:843-522-7889
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05501900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5164800Medicaid
NJ882522Medicare ID - Type Unspecified
NJ5164800Medicaid