Healthcare Provider Details

I. General information

NPI: 1922214030
Provider Name (Legal Business Name): KERRY KIRIFIDES, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 AAA BLVD SUITE C
NEWARK DE
19713-3624
US

IV. Provider business mailing address

875 AAA BLVD SUITE C
NEWARK DE
19713-3624
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 Number2007216425
License Number StateDE

VIII. Authorized Official

Name: DR. KERRY S. KIRIFIDES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 302-918-6400