Provider Demographics
NPI:1508865262
Name:KIRIFIDES, KERRY A (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:KIRIFIDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:S
Other - Last Name:KIRIFIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:875 AAA BOULEVARD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-918-6400
Mailing Address - Fax:302-918-6412
Practice Address - Street 1:875 AAA BOULEVARD
Practice Address - Street 2:SUITE C
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-918-6400
Practice Address - Fax:302-918-6412
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000701701Medicaid
DE0000701701Medicaid
DEH35542Medicare UPIN