Provider Demographics
NPI:1417929217
Name:KIRCHER, KENNETH T (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:T
Last Name:KIRCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 RT 9W
Mailing Address - Street 2:PO BOX 774
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-0774
Mailing Address - Country:US
Mailing Address - Phone:845-336-8572
Mailing Address - Fax:845-336-8592
Practice Address - Street 1:2215 RT 9W
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-0774
Practice Address - Country:US
Practice Address - Phone:845-336-8572
Practice Address - Fax:845-336-8592
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2106171207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H96694Medicare UPIN
3K0931Medicare ID - Type Unspecified