Healthcare Provider Details

I. General information

NPI: 1235266677
Provider Name (Legal Business Name): JOHN C. KIRKHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 WESTERN AVE
SOUTH PORTLAND ME
04106-2430
US

IV. Provider business mailing address

244 WESTERN AVE
SOUTH PORTLAND ME
04106-2430
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-3446
  • Fax:
Mailing address:
  • Phone: 207-775-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL-228993
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD20009
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number17368
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number242158
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: