Provider Demographics
NPI:1154319549
Name:MCGEAGH, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MCGEAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:MCGEAGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:600 RIDGELY AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1045
Mailing Address - Country:US
Mailing Address - Phone:410-266-8049
Mailing Address - Fax:410-266-8054
Practice Address - Street 1:600 RIDGELY AVE STE 130
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1045
Practice Address - Country:US
Practice Address - Phone:104-266-8049
Practice Address - Fax:410-266-8054
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063669208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016199M65Medicare PIN
I25946Medicare UPIN