Provider Demographics
NPI:1922003581
Name:KURIC, KEVIN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARTIN
Last Name:KURIC
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 1:3910 CAUGHEY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4041
Mailing Address - Country:US
Mailing Address - Phone:814-877-5401
Mailing Address - Fax:814-877-5400
Practice Address - Street 1:3910 CAUGHEY RD STE 150
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4041
Practice Address - Country:US
Practice Address - Phone:814-877-5401
Practice Address - Fax:814-877-5400
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039465E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080090356OtherRR MEDICARE
PA0011673780009Medicaid
PA849469OtherAETNA
NY00025972601OtherUNIVERA
PA534195OtherBLUE SHIELD
PAP000366OtherGATEWAY
NY01413827OtherNY MEDICAL ASSISTANCE
PA128943OtherUNISON
PA305105OtherUPMC
OH0915460OtherOH MEDICAL ASSISTANCE
PA849469OtherAETNA
PA305105OtherUPMC