Provider Demographics
NPI:1669492930
Name:KEARNEY, SETH ANDREW (DPM)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:ANDREW
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-589-3100
Mailing Address - Fax:740-566-4015
Practice Address - Street 1:2131 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1560
Practice Address - Country:US
Practice Address - Phone:740-589-3100
Practice Address - Fax:740-566-4015
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003435213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012073Medicaid
OH310917085-185OtherOHIO MEDICAID CARESOURCE
P00327138OtherRAILROAD MEDICARE
OH2829103OtherOHIO MEDICAD MOLINA
OH2829103Medicaid
000000193563OtherUNISON
WV3810012073Medicaid
V09905Medicare UPIN