Provider Demographics
NPI:1972514958
Name:ANBARI, KEVIN KINAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KINAN
Last Name:ANBARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KINAN
Other - Middle Name:
Other - Last Name:ANBARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:798 HAUSMAN RD FL 1
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9108
Practice Address - Country:US
Practice Address - Phone:610-402-8900
Practice Address - Fax:610-402-5656
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420334207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2832707000OtherINDEPENDENCE BLUE CROSS
PA7366876OtherAETNA
PA821657OtherFIRST PRIORITY HEALTH
PA1018599110001Medicaid
PA107715OtherGEISINGER
7366876/1553034OtherAETNA
PA1935659OtherBLUE SHIELD
50004696OtherBLUE CROSS/KEYSTONE CENTR
I43557Medicare UPIN
PA109318EDCMedicare PIN