MEDICARE: KEVIN SCOTT MCCANN MD

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
1	207Q00000X	Family Medicine Physician	18651	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346201191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN SCOTT MCCANN MD

Provider Business Mailing Address
First Line	:	4600 ROUTE 152
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-9702
Country	:	US
Telephone Number	:	304-697-9480
Fax Number	:	304-697-9491

Provider Business Practice Location Address
First Line	:	4600 ROUTE 152
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-9702
Country	:	US
Telephone Number	:	304-697-9480
Fax Number	:	304-697-9491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	11/24/2021

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