Provider Demographics
NPI:1598759128
Name:KIRSCH, PAUL BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRUCE
Last Name:KIRSCH
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 1:601 HEDGEHOG LN
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2914
Mailing Address - Country:US
Mailing Address - Phone:814-362-2625
Mailing Address - Fax:814-362-6243
Practice Address - Street 1:2 N CENTER ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1903
Practice Address - Country:US
Practice Address - Phone:814-362-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038201E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA155108SRUMedicare PIN
PAB40118Medicare UPIN