Provider Demographics
NPI:1235193194
Name:HANEY, KEVIN MARK (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARK
Last Name:HANEY
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:# L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:6 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1047
Practice Address - Country:US
Practice Address - Phone:740-363-9021
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082328H207Q00000X
OH35.082328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2424728Medicaid
7507586OtherAETNA
OH000000343647OtherANTHEM BCBS
0112975OtherUHC
OH2424728Medicaid
311098079OtherPPONEXT
353077OtherSUBMITTER NUMBER
0112975OtherUHC
311098079OtherPPONEXT
H93840Medicare UPIN
P00153378Medicare ID - Type UnspecifiedRR