Provider Demographics
NPI:1528256872
Name:DEHART, KEVIN EUGENE (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EUGENE
Last Name:DEHART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6160 KEMPSVILLE CIR
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3933
Mailing Address - Country:US
Mailing Address - Phone:757-622-6315
Mailing Address - Fax:757-622-7021
Practice Address - Street 1:3907 BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1133
Practice Address - Country:US
Practice Address - Phone:757-622-6315
Practice Address - Fax:757-622-7022
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102203158207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6538AOtherMEDICARE PTAN
VA0102203158OtherVIRGINIA BOARD OF MEDICINE