Provider Demographics
NPI:1447478995
Name:DENICOFF, KIRK DAVID (MD)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:DAVID
Last Name:DENICOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11121 KORMAN DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2046
Mailing Address - Country:US
Mailing Address - Phone:301-983-2753
Mailing Address - Fax:301-983-2754
Practice Address - Street 1:5411 W CEDAR LN
Practice Address - Street 2:SUITE 207A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1516
Practice Address - Country:US
Practice Address - Phone:301-983-2753
Practice Address - Fax:301-983-2754
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD325942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE74012Medicare UPIN