Provider Demographics
NPI:1962523431
Name:BROWNGOEHL, KEVIN HENRY (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:HENRY
Last Name:BROWNGOEHL
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 1:5030 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4605
Mailing Address - Country:US
Mailing Address - Phone:610-623-9080
Mailing Address - Fax:610-623-3861
Practice Address - Street 1:5030 STATE RD
Practice Address - Street 2:SUITE 2-900
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4605
Practice Address - Country:US
Practice Address - Phone:610-623-9080
Practice Address - Fax:610-623-3861
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAB3130438208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010080770002Medicaid
F14231Medicare UPIN