Provider Demographics
NPI:1508873738
Name:KIRK, MALCOLM M (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:M
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 1:68 CUMBERLAND STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895
Mailing Address - Country:US
Mailing Address - Phone:401-762-3838
Mailing Address - Fax:401-753-8252
Practice Address - Street 1:68 CUMBERLAND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895
Practice Address - Country:US
Practice Address - Phone:401-752-3838
Practice Address - Fax:401-762-8252
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10373207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7008376Medicaid
RI069080039Medicare PIN
RI7008376Medicaid
RIF69088Medicare UPIN
RI007060822Medicare PIN
RI007060273Medicare PIN