Provider Demographics
NPI:1275793440
Name:KIRIAKIDI, KIRA O (MD)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:O
Last Name:KIRIAKIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:O
Other - Last Name:MAZUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1850 BRIGHTON HENRIETTA TOWN LINE RD
Mailing Address - Street 2:C/O CREDENTIALING DEPARTMENT
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2532
Mailing Address - Country:US
Mailing Address - Phone:585-452-8114
Mailing Address - Fax:585-452-8111
Practice Address - Street 1:470 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3057
Practice Address - Country:US
Practice Address - Phone:585-227-7600
Practice Address - Fax:585-227-8322
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine