Provider Demographics
NPI:1154328904
Name:KIRSHNER, RONALD L (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:KIRSHNER
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 1:1415 PORTLAND AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3038
Mailing Address - Country:US
Mailing Address - Phone:585-544-6550
Mailing Address - Fax:585-338-2997
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-544-6550
Practice Address - Fax:585-338-2997
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144645208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0901886Medicaid
NYB71999Medicare UPIN
NY0901886Medicaid