Provider Demographics
NPI:1164502126
Name:KIRBY, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KIRBY
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 1:1210 BRACE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3213
Mailing Address - Country:US
Mailing Address - Phone:856-428-6616
Mailing Address - Fax:856-428-4823
Practice Address - Street 1:1210 BRACE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3213
Practice Address - Country:US
Practice Address - Phone:856-428-6616
Practice Address - Fax:856-428-4823
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA54296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1019626OtherHORIZON NJ HEALTH
13534OtherUNIVERSITY HEALTHPLAN
1547548OtherUNITED HEALTHCARE
501721OtherAETNA
0447390000OtherAMERIHEALTH, KEYSTONE, IBC
NJ0599409Medicaid
0499597OtherCIGNA
0447390000OtherAMERIHEALTH, KEYSTONE, IBC
0499597OtherCIGNA