Provider Demographics
NPI:1841276987
Name:O'MALLEY, KEVIN CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHARLES
Last Name:O'MALLEY
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:PSC 482, P.O BOX 53
Mailing Address - Street 2:FPO-AP
Mailing Address - City:CHATAN-CHO
Mailing Address - State:OKINAWA
Mailing Address - Zip Code:96362
Mailing Address - Country:JP
Mailing Address - Phone:01181098-645-7338
Mailing Address - Fax:
Practice Address - Street 1:USNH OKINAWA
Practice Address - Street 2:PSC 482, FPO-AP
Practice Address - City:CHATAN-CHO
Practice Address - State:OKINAWA
Practice Address - Zip Code:96362
Practice Address - Country:JP
Practice Address - Phone:01181098-936-7338
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8686207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine