Healthcare Provider Details

I. General information

NPI: 1740271139
Provider Name (Legal Business Name): ROBERT A KIRK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 NEW HOLLAND AVE
LANCASTER PA
17602-2137
US

IV. Provider business mailing address

794 NEW HOLLAND AVE
LANCASTER PA
17602-2137
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-3782
  • Fax: 717-560-3787
Mailing address:
  • Phone: 717-560-3782
  • Fax: 717-560-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD043037E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: