Provider Demographics
NPI:1548265648
Name:KAVIC, TIMOTHY N (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:N
Last Name:KAVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2998
Mailing Address - Country:US
Mailing Address - Phone:878-313-3338
Mailing Address - Fax:878-313-3339
Practice Address - Street 1:500 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2998
Practice Address - Country:US
Practice Address - Phone:878-313-3338
Practice Address - Fax:878-313-3339
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021968E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000989481 0004Medicaid
PA104432Medicare PIN
PA088521Medicare UPIN
PAC30127Medicare UPIN