Basic Information
| Provider Information | |||||||||
| NPI: | 1639669591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINCAID | ||||||||
| FirstName: | BRAD | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 MIDLANDS DR | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060012324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612340640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060301782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792147 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2018 | ||||||||
| LastUpdateDate: | 07/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 125.071790 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.