Provider Demographics
NPI:1295772341
Name:PRICE, KEVIN DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DAVID
Last Name:PRICE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:910-754-4441
Mailing Address - Fax:910-754-5307
Practice Address - Street 1:512 VILLAGE RD STE 205
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-3409
Practice Address - Country:US
Practice Address - Phone:910-754-4441
Practice Address - Fax:910-754-5307
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00608207R00000X
MA223240207R00000X
NC2007-01857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ57009Medicaid
NC5908618Medicaid
NC2401620Medicare PIN
NC2401620BMedicare PIN
NC5908618Medicaid