Provider Demographics
NPI:1851685549
Name:PADUCHOWSKI, KEVIN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALAN
Last Name:PADUCHOWSKI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:170 MANNING DR
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MED. POB., 1ST FL.,CB#7594
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4221
Mailing Address - Country:US
Mailing Address - Phone:919-966-6442
Mailing Address - Fax:919-966-3049
Practice Address - Street 1:170 MANNING DR
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MED. POB., 1ST FL.,CB#7594
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4221
Practice Address - Country:US
Practice Address - Phone:919-966-6442
Practice Address - Fax:919-966-3049
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2023-02-01
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Provider Licenses
StateLicense IDTaxonomies
NC172705390200000X
NC2013-00388207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program