Healthcare Provider Details

I. General information

NPI: 1710804885
Provider Name (Legal Business Name): KEVIN CARTHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5913 KINGS GROVE DR
CHESTERFIELD VA
23832-7896
US

IV. Provider business mailing address

6514 REGAL GROVE LN
CHESTERFIELD VA
23832-8486
US

V. Phone/Fax

Practice location:
  • Phone: 804-332-9869
  • Fax:
Mailing address:
  • Phone: 804-332-9869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: