Provider Demographics
NPI:1114919586
Name:QUIRK, MICHAEL PAUL (PHD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PAUL
Last Name:QUIRK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 CROSS GATE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-6324
Mailing Address - Country:US
Mailing Address - Phone:336-408-4851
Mailing Address - Fax:
Practice Address - Street 1:1049 CROSS GATE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-6324
Practice Address - Country:US
Practice Address - Phone:336-408-4851
Practice Address - Fax:336-408-4851
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2134103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046PEOtherBCBS NC
NC477021OtherHUMANA GOLD CHOICE
NC6000641Medicaid
NC2822389AMedicare PIN