Provider Demographics
NPI:1851323323
Name:JUENGST, KIRBY N (MD)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:N
Last Name:JUENGST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1619
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-283-5400
Practice Address - Fax:413-284-5559
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53029208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1293210OtherFALLON COMMUNITY HEALTH
530291OtherCONNECTICARE
A57143Medicare UPIN
4390356OtherHEALTHSOURCE CMHC
053029OtherTUFTS COMMUNTIY HEALTH
J03944OtherBLUE CROSS/BLUE SHIELD
1900071OtherUNITED HEALTH CARE
340011235OtherRAILROAD MEDICARE
MA6186475Medicaid
27717OtherHARVARD PILGRIM
4390356OtherCIGNA
984958OtherNETWORK HEALTH
J03944Medicare ID - Type Unspecified