Provider Demographics
NPI:1194895912
Name:NAMAY, KEVAN A (MD)
Entity type:Individual
Prefix:
First Name:KEVAN
Middle Name:A
Last Name:NAMAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE SEAVE B16
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-5848
Mailing Address - Fax:304-388-9654
Practice Address - Street 1:3411 NOYES AVE STE B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1351
Practice Address - Country:US
Practice Address - Phone:304-720-3206
Practice Address - Fax:304-720-3209
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0047080001Medicaid
WV0047080001Medicaid
E67382Medicare UPIN
0680543Medicare ID - Type Unspecified