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NPI Code Detail

MEDICARE: DR. KEVIN MICHAEL O'MEARA M.D.

MEDICARE: DR. KEVIN MICHAEL O'MEARA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080P0206XPediatric Gastroenterology Physician0101229426VA
2208000000XPediatrics Physician0101229426VA

General Provider Information

NPI Number : 1194709816
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN MICHAEL O'MEARA M.D.
Provider Business Mailing Address
First Line : 9300 DEWITT LOOP
Second Line :
City : FT BELVOIR
State : VA
Zip : 22060-5285
Country : US
Telephone Number : 571-231-1066
Fax Number :
Provider Business Practice Location Address
First Line : 9300 DEWITT LOOP
Second Line :
City : FT BELVOIR
State : VA
Zip : 22060-5285
Country : US
Telephone Number : 571-231-1066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 01/13/2025

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