Provider Demographics
NPI:1447249537
Name:KIRK, JEAN H (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:H
Last Name:KIRK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:BROAD AND VINE STREETS
Mailing Address - Street 2:MS310
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:215-762-1808
Mailing Address - Fax:215-762-1255
Practice Address - Street 1:BROAD AND VINE STREETS
Practice Address - Street 2:MS310
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:215-762-1808
Practice Address - Fax:215-762-1255
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041645L2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E65443Medicare UPIN
908824Medicare ID - Type Unspecified