Healthcare Provider Details

I. General information

NPI: 1245265784
Provider Name (Legal Business Name): KIRK ROBERT HASENMUELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BURLINGTON DR
CLARKSVILLE VA
23927-3235
US

IV. Provider business mailing address

61 BURLINGTON DR
CLARKSVILLE VA
23927-3235
US

V. Phone/Fax

Practice location:
  • Phone: 434-374-2773
  • Fax: 434-374-4202
Mailing address:
  • Phone: 434-374-2773
  • Fax: 434-374-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9600276
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101258374
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: