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General NPI Number Information
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NPI Number | 1407311624
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Entity Type | Individual
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Provider Name | MATTHEW THOMAS KIRK PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 333 BORTHWICK AVE
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City | PORTSMOUTH
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State | NH
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Zip | 03801-7128
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Country | US
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Telephone | 603-433-4890
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Fax | 603-433-5185
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Provider Business Mailing Address
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Address Line | 7 ENO DR
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City | EXETER
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State | NH
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Zip | 03833-7506
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Country | US
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Telephone | 207-939-8879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1437
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License Number State | NH
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