Healthcare Provider Details

I. General information

NPI: 1568696110
Provider Name (Legal Business Name): STEPHEN ELLIOTT KIRSHENBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDREN'S LANE EVMS PEDIATRICS
NORFOLK VA
23507
US

IV. Provider business mailing address

601 CHILDREN'S LANE EVMS PEDIATRICS
NORFOLK VA
23507
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7272
  • Fax:
Mailing address:
  • Phone: 757-668-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101251582
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: