Healthcare Provider Details

I. General information

NPI: 1477528933
Provider Name (Legal Business Name): WILLIAM J KIRSCH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NASON DR
ROARING SPRING PA
16673-1202
US

IV. Provider business mailing address

PO BOX 139
STATE COLLEGE PA
16804-0139
US

V. Phone/Fax

Practice location:
  • Phone: 814-224-6215
  • Fax: 814-224-6247
Mailing address:
  • Phone: 814-235-7686
  • Fax: 814-235-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM J KIRSCH
Title or Position: OWNER
Credential: MD
Phone: 814-224-6215