Provider Demographics
NPI:1689632556
Name:KIRBY, CRAIG R (DO)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:KIRBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ELM ST
Mailing Address - Street 2:FAMILY PRACTICE ASSOC.
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6502
Mailing Address - Country:US
Mailing Address - Phone:413-442-1019
Mailing Address - Fax:
Practice Address - Street 1:20 ELM ST
Practice Address - Street 2:FAMILY PRACTICE ASSOC.
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6502
Practice Address - Country:US
Practice Address - Phone:413-442-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3119459Medicaid
J14300Medicare PIN
E89464Medicare UPIN
MA3119459Medicaid