Kavanagh, Mark L

Kavanagh, Mark L is an individual health care provider with primary practice located at 61 Beaverbrook Rd Suite 201, Lincoln Park NJ 07035-1748. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sports Medicine, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Kavanagh, Mark L can be contacted via phone (973) 686-9292.

Contact Information

Primary practice address
61 Beaverbrook Rd Suite 201 Lincoln Park NJ 07035-1748
Phone: (973) 686-9292
Fax: (973) 686-9294
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 0101245447 Virginia
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 25MA08991900 New Jersey

Profile Details

NPI number 1558514380
LBN Legal business name Kavanagh, Mark L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2008
Last updated Jan 2nd, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558514380 NPPES
Virginia Other 1558514380 BCBS
Virginia MEDICAID 1558514380 BCBS

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