MEDICARE: ERIC DAVID KIRSCH PA-C

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	363AM0700X	Medical Physician Assistant	103668	NC

General Provider Information

NPI Number	:	1881658219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DAVID KIRSCH PA-C

Provider Business Mailing Address
First Line	:	5960 FAIRVIEW RD
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3102
Country	:	US
Telephone Number	:	704-496-2760
Fax Number	:	888-477-0432

Provider Business Practice Location Address
First Line	:	5960 FAIRVIEW RD
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3102
Country	:	US
Telephone Number	:	704-496-2760
Fax Number	:	888-477-0432

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/15/2008

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