Healthcare Provider Details

I. General information

NPI: 1144459124
Provider Name (Legal Business Name): KEVIN JOSEPH CARL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SHAW AVE FL 3
MCKEESPORT PA
15132-2918
US

IV. Provider business mailing address

331 SHAW AVE FL 3
MCKEESPORT PA
15132-2918
US

V. Phone/Fax

Practice location:
  • Phone: 412-675-6927
  • Fax: 412-672-3443
Mailing address:
  • Phone: 412-675-6927
  • Fax: 412-672-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA11787900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD443748
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: