Healthcare Provider Details

I. General information

NPI: 1508865262
Provider Name (Legal Business Name): KERRY A. KIRIFIDES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY S. KIRIFIDES M.D.

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 AAA BOULEVARD SUITE C
NEWARK DE
19713
US

IV. Provider business mailing address

875 AAA BOULEVARD SUITE C
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-918-6400
  • Fax: 302-918-6412
Mailing address:
  • Phone: 302-918-6400
  • Fax: 302-918-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0004785
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: