Provider Demographics
NPI:1902115454
Name:J.E. TERENCE KAVANAGH,MD,INC.
Entity Type:Organization
Organization Name:J.E. TERENCE KAVANAGH,MD,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:KAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-393-5544
Mailing Address - Street 1:2660 SOUTH ST SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6230
Mailing Address - Country:US
Mailing Address - Phone:330-393-5544
Mailing Address - Fax:330-393-5546
Practice Address - Street 1:2660 SOUTH ST SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6230
Practice Address - Country:US
Practice Address - Phone:330-393-5544
Practice Address - Fax:330-393-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0172085Medicaid
OH0172085Medicaid