Provider Demographics
NPI:1538100672
Name:O'HARA, KEVIN W (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:O'HARA
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:PO BOX 5930
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-0930
Mailing Address - Country:US
Mailing Address - Phone:302-995-2090
Mailing Address - Fax:302-995-1121
Practice Address - Street 1:2006 LIMESTONE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5553
Practice Address - Country:US
Practice Address - Phone:302-995-2090
Practice Address - Fax:302-995-1121
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000463801Medicaid
DE0000463801Medicaid
DE00A503D48Medicare ID - Type Unspecified