Provider Demographics
NPI:1346439767
Name:KIRKPATRICK, SALLY E K (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:E K
Last Name:KIRKPATRICK
Suffix:
Gender:F
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:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0410
Mailing Address - Country:US
Mailing Address - Phone:207-947-0558
Mailing Address - Fax:207-947-0344
Practice Address - Street 1:498 ESSEX ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3990
Practice Address - Country:US
Practice Address - Phone:207-947-0558
Practice Address - Fax:207-947-0344
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0143182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7735181OtherAETNA
ME040791OtherANTHEM
ME6912528OtherCIGNA
ME7735181OtherAETNA
MM664401Medicare PIN