Healthcare Provider Details

I. General information

NPI: 1104183649
Provider Name (Legal Business Name): KEVIN P MCANINCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 OLENTANGY RIVER ROAD SUITE 1080
COLUMBUS OH
43214-3984
US

IV. Provider business mailing address

3555 OLENTANGY RIVER ROAD SUITE 1080
COLUMBUS OH
43214-3984
US

V. Phone/Fax

Practice location:
  • Phone: 614-268-8134
  • Fax: 614-268-8406
Mailing address:
  • Phone: 614-268-8134
  • Fax: 614-268-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34011598
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.011598
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: