Individual
KEVIN O BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
107 OMNI DR, STE B, SENECA, SC 29672-9448
(864) 885-7881
(864) 885-7885
Mailing address
107 OMNI DR, STE B, SENECA, SC 29672-9448
(864) 885-7881
(864) 885-7885
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
1063
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010632
—
SC
01
—
AA1887
MEDICARE PTAN
SC
01
—
E500
MEDICARE PTAN
SC
05
—
GP4697
—
SC
Enumeration date
02/07/2006
Last updated
04/06/2017
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