Provider Demographics
NPI:1609886167
Name:KERLIN, KEVIN JAMES (MD, FACRO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:KERLIN
Suffix:
Gender:M
Credentials:MD, FACRO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2802 MCLAMB PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1600
Practice Address - Country:US
Practice Address - Phone:919-734-7265
Practice Address - Fax:919-734-6421
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35393174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5457621OtherAETNA
NCP01016591OtherRAILROAD MEDICARE
NC7524615OtherCIGNA
NC8948552Medicaid
NCP01016591OtherRAILROAD MEDICARE
NC8948552Medicaid
2174930BMedicare PIN
NC2174930CMedicare PIN