Provider Demographics
NPI:1073636338
Name:KIRSNER, ROBERT E (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:KIRSNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2603
Mailing Address - Country:US
Mailing Address - Phone:978-462-2483
Mailing Address - Fax:978-462-2483
Practice Address - Street 1:14 HARRIS ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2603
Practice Address - Country:US
Practice Address - Phone:978-462-2483
Practice Address - Fax:978-462-2483
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1789213EP1101X
NH0188213EP1101X
FLP00001988213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0362417Medicaid
MA2701772OtherEVERCARE
MAKI Y 70867Medicare ID - Type Unspecified
MA2701772OtherEVERCARE