Individual provider Active NPI

Mary B. Kawan, MD

  • Pediatrics Physician
  • Philadelphia, PA
National Provider Identifier
1801895727
Registry record updated Aug 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD432359 Issued in PA
Practice address
4865 Market St
Philadelphia, PA 19139-3508
Phone
(267) 425-9800
Fax
(267) 425-9999
NPI assigned
Jul 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 23275 SC
Pediatrics Physician 208000000X 25MA09049500 NJ
Pediatrics Physician 208000000X MD432359 PA Primary

Addresses

Primary practice location

4865 Market St
Philadelphia, PA 19139-3508

Mailing address

4865 Market St
Philadelphia, PA 19139-3508
Phone (267) 425-9800

Other names 1

  • Mary B. Bradley Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA09049500NJMDPediatrics Physician
MD432359PAMDPediatrics Physician
23275SCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital of Philadelphia Pediatrics Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438646400000",
    "number": "1801895727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4865 MARKET ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191393508",
            "telephone_number": "267-425-9800",
            "fax_number": "267-425-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4865 MARKET ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191393508",
            "telephone_number": "267-425-9800",
            "fax_number": "267-425-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAWAN",
        "first_name": "MARY",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-21",
        "last_updated": "2015-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "23275",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA09049500",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD432359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "BRADLEY",
            "middle_name": "B.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.