Provider Demographics
NPI:1285802876
Name:VERMA, KEWAL K (MD)
Entity type:Individual
Prefix:DR
First Name:KEWAL
Middle Name:K
Last Name:VERMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1642 SUITE A PELHAM ROAD SOUTH
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265
Mailing Address - Country:US
Mailing Address - Phone:256-365-2233
Mailing Address - Fax:256-365-2187
Practice Address - Street 1:1642 PELHAM RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3312
Practice Address - Country:US
Practice Address - Phone:256-365-2233
Practice Address - Fax:256-365-2187
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7306172V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
C72876Medicare UPIN