Basic Information
| Provider Information | |||||||||
| NPI: | 1851685549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADUCHOWSKI | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 MANNING DR | ||||||||
| Address2: | DEPARTMENT OF EMERGENCY MED. POB., 1ST FL.,CB#7594 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199666442 | ||||||||
| FaxNumber: | 9199663049 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 MANNING DR | ||||||||
| Address2: | DEPARTMENT OF EMERGENCY MED. POB., 1ST FL.,CB#7594 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199666442 | ||||||||
| FaxNumber: | 9199663049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2011 | ||||||||
| LastUpdateDate: | 03/13/2014 | ||||||||
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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 | 390200000X | 172705 | NC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.