Provider Demographics
NPI:1700830189
Name:AHERN, J KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:KEVIN
Last Name:AHERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2687
Mailing Address - Country:US
Mailing Address - Phone:937-390-9665
Mailing Address - Fax:937-215-6933
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2687
Practice Address - Country:US
Practice Address - Phone:937-390-9665
Practice Address - Fax:937-215-6933
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.058701207QH0002X
OH35058701A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2418119Medicaid
OHH238140Medicare PIN
OH2418119Medicaid