MEDICARE: DR. KRYDER EVANS VAN BUSKIRK III 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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	333099	KY

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

General Provider Information

NPI Number	:	1548232598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRYDER EVANS VAN BUSKIRK III M.D,

Provider Business Mailing Address
First Line	:	PO BOX 30309
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29417-0309
Country	:	US
Telephone Number	:	843-554-9300
Fax Number	:	843-566-8780

Provider Business Practice Location Address
First Line	:	217 S 3RD ST
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40422-1823
Country	:	US
Telephone Number	:	853-239-2448
Fax Number	:	843-284-3401

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	02/21/2008

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