MEDICARE: DR. JOSEPH JAMES KAVANAGH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	042-0011291	VT
2	2085R0202X	Diagnostic Radiology Physician	04-33259	KS
3	2085R0202X	Diagnostic Radiology Physician	414164	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275614612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH JAMES KAVANAGH M.D.

Provider Business Mailing Address
First Line	:	21 COCONUT LN
Second Line	:
City	:	OCEAN RIDGE
State	:	FL
Zip	:	33435-5202
Country	:	US
Telephone Number	:	305-331-9580
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 COCONUT LN
Second Line	:
City	:	OCEAN RIDGE
State	:	FL
Zip	:	33435-5202
Country	:	US
Telephone Number	:	305-331-9580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/25/2025

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Directions to “ DR. JOSEPH JAMES KAVANAGH M.D.” Practice Location

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