Individual
MARK L KAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
61 BEAVERBROOK RD, SUITE 201, LINCOLN PARK, NJ 07035-1748
(973) 686-9292
(973) 686-9294
Mailing address
61 BEAVERBROOK RD, SUITE 201, LINCOLN PARK, NJ 07035-1748
(973) 686-9292
(973) 686-9294
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
25MA08991900
NJ
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
0101245447
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558514380
BCBS
VA
05
—
1558514380
—
VA
Enumeration date
10/24/2008
Last updated
01/02/2014
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