Provider Demographics
NPI:1225007784
Name:KIRSCH, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:KIRSCH
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 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3252
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-4188
Practice Address - Fax:704-384-5299
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC219862085R0001X
SC149712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2086552OtherUNITED HEALTHCARE
SCN21986Medicaid
NC2235310009OtherCIGNA
NC26017OtherPARTNERS
NC49307OtherBLUE CROSS
NC8949307Medicaid
NC48390OtherMEDCOST
NC49307OtherBLUE CROSS
NC2086552OtherUNITED HEALTHCARE
SCN21986Medicaid
NC212375FMedicare ID - Type UnspecifiedUNIVERSITY RAD ONC CTR
NC212375GMedicare ID - Type UnspecifiedLAKE NORMAN RAD ONC CTR