Provider Demographics
NPI:1770535296
Name:BREWSTER, KEVIN J (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:BREWSTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:344 AZALEA DRIVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-630-0920
Mailing Address - Fax:717-634-2237
Practice Address - Street 1:1 KINGS DR
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2331
Practice Address - Country:US
Practice Address - Phone:410-756-5323
Practice Address - Fax:410-756-5326
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0058598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH46868Medicare UPIN