Healthcare Provider Details

I. General information

NPI: 1477655371
Provider Name (Legal Business Name): KATHRYN E KIRK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 FRIENDSHIP BLVD SUITE T-90
CHEVY CHASE MD
20815-7256
US

IV. Provider business mailing address

12510 PROSPERITY DR SUITE 200
SILVER SPRING MD
20904-1663
US

V. Phone/Fax

Practice location:
  • Phone: 301-654-2521
  • Fax: 301-654-2986
Mailing address:
  • Phone: 240-485-5200
  • Fax: 301-625-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number218164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: