Provider Demographics
NPI:1437205234
Name:KIRKLAND, CLEMENT STOKES JR (MD)
Entity Type:Individual
Prefix:
First Name:CLEMENT
Middle Name:STOKES
Last Name:KIRKLAND
Suffix:JR
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 1:425 W 20TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2128
Mailing Address - Country:US
Mailing Address - Phone:757-622-6520
Mailing Address - Fax:757-622-7205
Practice Address - Street 1:425 W 20TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2128
Practice Address - Country:US
Practice Address - Phone:757-622-6520
Practice Address - Fax:757-622-7205
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11048OtherOPTIMA HEALTH
VA005618622Medicaid
432130OtherBLUE CROSS BLUE SHIELD
432130OtherBLUE CROSS BLUE SHIELD
VA005618622Medicaid