Provider Demographics
NPI:1700839255
Name:GIADROSICH, KEVIN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:SCOTT
Last Name:GIADROSICH
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:PO BOX 830230
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0230
Mailing Address - Country:US
Mailing Address - Phone:205-250-6000
Mailing Address - Fax:205-250-6848
Practice Address - Street 1:2112 ROCKY RIDGE RD
Practice Address - Street 2:STE. 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-5138
Practice Address - Country:US
Practice Address - Phone:205-545-8550
Practice Address - Fax:205-822-0136
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25019207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554841Medicaid
AL051554841Medicaid
051554841Medicare PIN