Healthcare Provider Details

I. General information

NPI: 1477643294
Provider Name (Legal Business Name): KEVIN JAMES CAREY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S RIVER ST SUITE 200
PLAINS PA
18705-1137
US

IV. Provider business mailing address

220 RIVER RD STE 200
PLAINS PA
18705-1137
US

V. Phone/Fax

Practice location:
  • Phone: 570-824-8151
  • Fax: 570-824-0111
Mailing address:
  • Phone: 570-824-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS009805L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: