Provider Demographics
NPI:1013939495
Name:MCCARTEN-GIBBS, KEVAN ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:KEVAN
Middle Name:ALEXANDER
Last Name:MCCARTEN-GIBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEVAN
Other - Middle Name:ALEXANDER
Other - Last Name:MCCARTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3259
Mailing Address - Fax:
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG783922080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5157102Medicaid
CAGR0095780Medicaid
CAF29460Medicare UPIN
NJMC724722Medicare ID - Type Unspecified
NJ5157102Medicaid