Provider Demographics
NPI:1790708188
Name:KIERNAN, KEVIN WIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WIGHT
Last Name:KIERNAN
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 1:4626 ASBURY PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4325
Mailing Address - Country:US
Mailing Address - Phone:202-362-9450
Mailing Address - Fax:
Practice Address - Street 1:4626 ASBURY PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4325
Practice Address - Country:US
Practice Address - Phone:202-362-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD135412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB94866Medicare UPIN
DC427041Medicare PIN