Provider Demographics
NPI:1366556292
Name:CARR, KEVIN LAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LAMAR
Last Name:CARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 BOSTON ST STE J1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5723
Mailing Address - Country:US
Mailing Address - Phone:410-522-0001
Mailing Address - Fax:410-522-0017
Practice Address - Street 1:3500 BOSTON ST STE J1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5723
Practice Address - Country:US
Practice Address - Phone:410-522-0001
Practice Address - Fax:410-522-0017
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086618207R00000X
PAMD436406207R00000X, 208M00000X
MDD0066548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20085401OtherAMERIHEALTH MERCY-WMG
PA264685OtherUNISON-WMG
PA102274965Medicaid
PA2093119OtherHIGHMARK BLUE SHIELD
MD933025OtherCAREFIRST MD BCBS
PA30131963OtherAMERIHEALTH MERCY - WMG
PA1580126OtherGATEWAY-WMG
OH2629472Medicaid
PA2093119OtherHIGHMARK BLUE SHIELD
PA264685OtherUNISON-WMG
PA1580126OtherGATEWAY-WMG
PA102274965Medicaid
I19578Medicare UPIN