Provider Demographics
NPI:1144211921
Name:KIRBER, WILLIAM MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARTIN
Last Name:KIRBER
Suffix:
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 1:31 PORTER ST
Mailing Address - Street 2:PO BOX 548
Mailing Address - City:LAKEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06039-1214
Mailing Address - Country:US
Mailing Address - Phone:860-435-0072
Mailing Address - Fax:860-435-9831
Practice Address - Street 1:31 PORTER ST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:CT
Practice Address - Zip Code:06039-1214
Practice Address - Country:US
Practice Address - Phone:860-435-0072
Practice Address - Fax:860-435-9831
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023349207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01101326Medicaid
CT001233493Medicaid
CT001233493Medicaid
B38418Medicare UPIN