Healthcare Provider Details

I. General information

NPI: 1306851589
Provider Name (Legal Business Name): BRENDAN P. KIRBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 ANDOVER RD
WESTBROOK ME
04092-3848
US

IV. Provider business mailing address

300 SOUTHBOROUGH DR SUITE 201
SOUTH PORTLAND ME
04106-6914
US

V. Phone/Fax

Practice location:
  • Phone: 207-761-2200
  • Fax: 207-761-2108
Mailing address:
  • Phone: 207-661-2018
  • Fax: 207-661-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD13039
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: