Provider Demographics
NPI:1629184585
Name:SHETH, KEVIN N (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:N
Last Name:SHETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:110 S PACA ST
Mailing Address - Street 2:3RD FLOOR, DEPARTMENT OF NEUROLOGY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1642
Mailing Address - Country:US
Mailing Address - Phone:443-615-4729
Mailing Address - Fax:
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:3RD FLOOR, DEPARTMENT OF NEUROLOGY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:443-615-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD693062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD69306OtherMEDICAL LICENSE