Provider Demographics
NPI:1366484198
Name:HINKLEY, KIRK S IV (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:S
Last Name:HINKLEY
Suffix:IV
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 1:2872 TURNPIKE ST
Mailing Address - Street 2:
Mailing Address - City:SUSQUEHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18847-2771
Mailing Address - Country:US
Mailing Address - Phone:570-853-3135
Mailing Address - Fax:
Practice Address - Street 1:25059 STATE ROUTE 11 STE A
Practice Address - Street 2:
Practice Address - City:HALLSTEAD
Practice Address - State:PA
Practice Address - Zip Code:18822-8831
Practice Address - Country:US
Practice Address - Phone:570-879-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260513207P00000X
OH87766207P00000X
PAMD446951207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026505170008Medicaid