Basic Information
| Provider Information | |||||||||
| NPI: | 1801824891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ST JOHN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST BLDG MKB | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512521 | ||||||||
| FaxNumber: | 7178513535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 06/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD036023E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001079856 | 05 | PA | MEDICAID | 1142448 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 542988 | 01 | MD | CAREFIRST MD BCBS | OTHER | 80737 | 01 | PA | UNISON-WMG | OTHER | P002885 | 01 | PA | GATEWAY-WMG | OTHER | 01107503 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 097074 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 4389930 | 01 | PA | AETNA | OTHER | 233290 | 01 | PA | MAMSI-WMG | OTHER | 30047 | 01 | PA | JOHNS HOPKINS | OTHER | 7273 | 01 | PA | GEISINGER | OTHER |