Provider Demographics
NPI:1285124438
Name:BARNUM, KEVIN JOHN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:BARNUM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE # KS133
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5491
Mailing Address - Country:US
Mailing Address - Phone:617-667-9200
Mailing Address - Fax:617-667-9922
Practice Address - Street 1:330 BROOKLINE AVE # KS133
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5491
Practice Address - Country:US
Practice Address - Phone:617-667-9920
Practice Address - Fax:617-667-9922
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1022639207RH0003X
CT67436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology