Healthcare Provider Details

I. General information

NPI: 1609371640
Provider Name (Legal Business Name): KEVIN DOUGLAS KIRKLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CAMBRIDGE ST
BOSTON MA
02114-2783
US

IV. Provider business mailing address

165 CAMBRIDGE ST
BOSTON MA
02114-2783
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-5058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2024031520
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number1028285
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: