Provider Demographics
NPI:1194785899
Name:KEPP, EDWARD A (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:KEPP
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 1:232 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4612
Mailing Address - Country:US
Mailing Address - Phone:704-986-3900
Mailing Address - Fax:
Practice Address - Street 1:232 CONCORD RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4612
Practice Address - Country:US
Practice Address - Phone:704-986-3900
Practice Address - Fax:704-986-3913
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00873207Q00000X
NC9400873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8947986Medicaid
NC14074OtherBCBS
NC47986OtherBCBS OF NC
NC14074OtherBCBS
NC2344328AMedicare PIN
NC47986OtherBCBS OF NC