MEDICARE: CLEMENT STOKES KIRKLAND JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101034390	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	11048	OTHER	OPTIMA HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	432130	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1437205234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEMENT STOKES KIRKLAND JR. M.D.

Provider Business Mailing Address
First Line	:	425 W 20TH ST
Second Line	:	SUITE 1
City	:	NORFOLK
State	:	VA
Zip	:	23517-2128
Country	:	US
Telephone Number	:	757-622-6520
Fax Number	:	757-622-7205

Provider Business Practice Location Address
First Line	:	425 W 20TH ST
Second Line	:	SUITE 1
City	:	NORFOLK
State	:	VA
Zip	:	23517-2128
Country	:	US
Telephone Number	:	757-622-6520
Fax Number	:	757-622-7205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	11/15/2013

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