Provider Demographics
NPI:1003917782
Name:KIRCHBERG, ROY W JR (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:W
Last Name:KIRCHBERG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 VIRGINIA WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7541
Mailing Address - Country:US
Mailing Address - Phone:615-221-4474
Mailing Address - Fax:615-234-3774
Practice Address - Street 1:5301 VIRGINIA WAY
Practice Address - Street 2:STE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7541
Practice Address - Country:US
Practice Address - Phone:615-221-4474
Practice Address - Fax:615-234-3774
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6276207ZP0102X
KY14073207ZP0102X
IN01037234207ZP0102X
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000005001351OtherTLC TENNCARE
TN3101520OtherBLUE CROSS
KY64776826Medicaid
TN119583OtherUNISON TENNCARE
TN3189193Medicaid
TN3101520OtherBLUE CROSS
D32178Medicare UPIN
TN000005001351OtherTLC TENNCARE
TN3189193Medicaid