Healthcare Provider Details

I. General information

NPI: 1902843667
Provider Name (Legal Business Name): JAMES E KIRBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE YAMINS 309 BETH ISRAEL DEACONESS/PATHOLOGY
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE YAMINS 309
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3648
  • Fax:
Mailing address:
  • Phone: 617-667-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number156123
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: