Provider Demographics
NPI:1801824891
Name:ST JOHN, KEVIN BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRIAN
Last Name:ST JOHN
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2521
Mailing Address - Fax:717-260-3330
Practice Address - Street 1:2003 SPRINGWOOD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4836
Practice Address - Country:US
Practice Address - Phone:717-851-2521
Practice Address - Fax:717-260-3330
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036023E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA233290OtherMAMSI-WMG
PA4389930OtherAETNA
PA80737OtherUNISON-WMG
PA097074OtherHIGHMARK BLUE SHIELD
PA01107503OtherCAPITAL BLUE CROSS-WMG
PA1142448OtherAMERIHEALTH MERCY-WMG
PA7273OtherGEISINGER
PAP002885OtherGATEWAY-WMG
PA30047OtherJOHNS HOPKINS
MD542988OtherCAREFIRST MD BCBS
PA001079856Medicaid
MD542988OtherCAREFIRST MD BCBS
PA080021862Medicare PIN
PA4389930OtherAETNA