Provider Demographics
NPI:1659557676
Name:KEVIN J. BREWSTER, D.O. LLC
Entity Type:Organization
Organization Name:KEVIN J. BREWSTER, D.O. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-630-0920
Mailing Address - Street 1:344 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3469
Mailing Address - Country:US
Mailing Address - Phone:717-630-0920
Mailing Address - Fax:717-630-0920
Practice Address - Street 1:1 KINGS DR
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2331
Practice Address - Country:US
Practice Address - Phone:717-630-0920
Practice Address - Fax:717-630-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0055845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty