Provider Demographics
NPI:1659699445
Name:MCHALE, KEVIN J (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:MCHALE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3685
Mailing Address - Country:US
Mailing Address - Phone:717-920-4400
Mailing Address - Fax:717-920-4401
Practice Address - Street 1:2808 OLD POST RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3685
Practice Address - Country:US
Practice Address - Phone:717-920-4400
Practice Address - Fax:717-920-4553
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017730207RC0000X
NJ25MB09056200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103044478Medicaid
PA103044478Medicaid