Healthcare Provider Details

I. General information

NPI: 1841276987
Provider Name (Legal Business Name): KEVIN CHARLES O'MALLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNH OKINAWA PSC 482, FPO-AP
CHATAN-CHO OKINAWA
96362
JP

IV. Provider business mailing address

PSC 482, P.O BOX 53 FPO-AP
CHATAN-CHO OKINAWA
96362
JP

V. Phone/Fax

Practice location:
  • Phone: 011810989367338
  • Fax:
Mailing address:
  • Phone: 011810986457338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD8686
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: