Provider Demographics
NPI:1407886542
Name:KIRKLAND, MATT L (MD)
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:L
Last Name:KIRKLAND
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 1:3400 CIVIC CENTER BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-662-2626
Mailing Address - Fax:215-614-0244
Practice Address - Street 1:3400 CIVIC CENTER BLVD FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-2626
Practice Address - Fax:215-614-0244
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032726E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001124780009Medicaid
PA001124780009Medicaid
PA133235Medicare ID - Type Unspecified