Healthcare Provider Details

I. General information

NPI: 1922267327
Provider Name (Legal Business Name): KEVIN M HIBBARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 STONEWOOD DR STE 151
WEXFORD PA
15090
US

IV. Provider business mailing address

7000 STONEWOOD DR STE 151
WEXFORD PA
15090
US

V. Phone/Fax

Practice location:
  • Phone: 724-933-0300
  • Fax: 724-933-0456
Mailing address:
  • Phone: 724-933-0300
  • Fax: 724-933-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD445101
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD445101
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: