Provider Demographics
NPI:1306851589
Name:KIRBY, BRENDAN P (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:P
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:300 SOUTHBOROUGH DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6914
Mailing Address - Country:US
Mailing Address - Phone:207-661-2018
Mailing Address - Fax:207-661-2033
Practice Address - Street 1:123 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3848
Practice Address - Country:US
Practice Address - Phone:207-761-2200
Practice Address - Fax:207-761-2108
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD130392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME206350099Medicaid
MEMM3179Medicare PIN
MEE400321873Medicare PIN
MEE69134Medicare UPIN