Provider Demographics
NPI:1942504295
Name:MEADOWCROFT, KEVIN MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:MEADOWCROFT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12208 BRITTINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-2214
Mailing Address - Country:US
Mailing Address - Phone:410-651-1410
Mailing Address - Fax:410-651-1594
Practice Address - Street 1:12208 BRITTINGHAM LN
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2214
Practice Address - Country:US
Practice Address - Phone:410-651-1410
Practice Address - Fax:410-651-1594
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC04486363AM0700X
MD363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant