1871592493 NPI number — DR. BRIAN M KIRSH MD

Table of content: DR. BRIAN M KIRSH MD (NPI 1871592493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871592493 NPI number — DR. BRIAN M KIRSH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRSH
Provider First Name:
BRIAN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871592493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 PARK EAST DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-4339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-593-7700
Provider Business Mailing Address Fax Number:
216-593-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 K ST NW STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20006-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-737-0085
Provider Business Practice Location Address Fax Number:
202-296-0301
Provider Enumeration Date:
07/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  MD049110 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: D0091413 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 091317312 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206385900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".