Provider Demographics
NPI:1568720183
Name:BALKCOM, KIRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRA
Middle Name:L
Last Name:BALKCOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRA
Other - Middle Name:L
Other - Last Name:FISET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-775-7111
Mailing Address - Fax:
Practice Address - Street 1:147 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4555
Practice Address - Country:US
Practice Address - Phone:802-775-1901
Practice Address - Fax:802-775-1974
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420013328207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1027735Medicaid