Provider Demographics
NPI:1477584811
Name:KIRK, JOHN WARREN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WARREN
Last Name:KIRK
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:PO BOX 2150
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-2150
Mailing Address - Country:US
Mailing Address - Phone:603-863-4196
Mailing Address - Fax:
Practice Address - Street 1:273 COUNTY ROAD
Practice Address - Street 2:1 MEDICAL CENTER DR
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-0000
Practice Address - Country:US
Practice Address - Phone:603-526-2911
Practice Address - Fax:603-650-1076
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011411Medicaid
VT0004155Medicaid
C65821Medicare UPIN
VT0004155Medicaid