Provider Demographics
NPI:1366556292
Name:CARR, KEVIN LAMAR (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LAMAR
Last Name:CARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HHC-CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-5507
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:2800 MAIN STREET
Practice Address - Street 2:LEVEL 1M
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4201
Practice Address - Country:US
Practice Address - Phone:475-210-5718
Practice Address - Fax:475-210-5263
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086618207R00000X
PAMD436406207R00000X, 208M00000X
MDD0066548207R00000X
CT79703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1580126OtherGATEWAY-WMG
MD933025OtherCAREFIRST MD BCBS
PA102274965Medicaid
PA2093119OtherHIGHMARK BLUE SHIELD
PA20085401OtherAMERIHEALTH MERCY-WMG
PA30131963OtherAMERIHEALTH MERCY - WMG
OH2629472Medicaid
PA264685OtherUNISON-WMG
PA2093119OtherHIGHMARK BLUE SHIELD
PA264685OtherUNISON-WMG
PA1580126OtherGATEWAY-WMG
PA102274965Medicaid
I19578Medicare UPIN