MEDICARE: DR. KEVIN CHARLES O'MALLEY 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	207P00000X	Emergency Medicine Physician	MD8686	HI

General Provider Information

NPI Number	:	1841276987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN CHARLES O'MALLEY M.D.

Provider Business Mailing Address
First Line	:	PSC 482, P.O BOX 53
Second Line	:	FPO-AP
City	:	CHATAN-CHO
State	:	OKINAWA
Zip	:	96362
Country	:	JP
Telephone Number	:	011810986457338
Fax Number	:

Provider Business Practice Location Address
First Line	:	USNH OKINAWA
Second Line	:	PSC 482, FPO-AP
City	:	CHATAN-CHO
State	:	OKINAWA
Zip	:	96362
Country	:	JP
Telephone Number	:	011810989367338
Fax Number	:

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	07/21/2022

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