Basic Information
| Provider Information | |||||||||
| NPI: | 1558565358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARMEN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1109 2ND AVE SW | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286022545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283276026 | ||||||||
| FaxNumber: | 3305888605 | ||||||||
| Practice Location | |||||||||
| Address1: | 1109 2ND AVE SW | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286022545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283276026 | ||||||||
| FaxNumber: | 8283278796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35.098114 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 2084A0401X | 141986 | NC | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0800X | DR.0059446 | CO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 207P00000X | D70363 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.