Provider Demographics
NPI:1639272909
Name:DELAHANTY, KEVIN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHARLES
Last Name:DELAHANTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:100 ROSEBROOK WAY
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1138
Practice Address - Country:US
Practice Address - Phone:508-273-4950
Practice Address - Fax:508-273-4951
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2020-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA230513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2130556OtherMASSHEALTH
MA2130556Medicaid
MA495710OtherTUFTS
MA2130556Medicaid