Provider Demographics
NPI:1184838286
Name:HEATH, KIRK W (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:W
Last Name:HEATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1120 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2418
Mailing Address - Country:US
Mailing Address - Phone:757-481-4424
Mailing Address - Fax:757-481-3820
Practice Address - Street 1:1120 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2418
Practice Address - Country:US
Practice Address - Phone:757-481-4424
Practice Address - Fax:757-481-3820
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-02245208600000X
VA0101241891208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7841936OtherAETNA
2169343OtherUNITED HEALTHCARE
VA1184838286Medicaid
P00602477OtherRAILROAD MEDICARE
8948166OtherCIGNA
016886C91Medicare PIN