Provider Demographics
NPI:1477051969
Name:KIRKWOOD, ZACHARY JON
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JON
Last Name:KIRKWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 LEOS WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LEONARD
Mailing Address - State:MD
Mailing Address - Zip Code:20685-2925
Mailing Address - Country:US
Mailing Address - Phone:443-684-8193
Mailing Address - Fax:
Practice Address - Street 1:1750 LEOS WAY
Practice Address - Street 2:
Practice Address - City:SAINT LEONARD
Practice Address - State:MD
Practice Address - Zip Code:20685-2925
Practice Address - Country:US
Practice Address - Phone:443-684-8193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer