Provider Demographics
NPI:1881658219
Name:KIRSCH, ERIC DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DAVID
Last Name:KIRSCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 FAIRVIEW RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3102
Mailing Address - Country:US
Mailing Address - Phone:704-496-2760
Mailing Address - Fax:888-477-0432
Practice Address - Street 1:5960 FAIRVIEW RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3102
Practice Address - Country:US
Practice Address - Phone:704-496-2760
Practice Address - Fax:888-477-0432
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103668363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P91256Medicare UPIN
NC2758772DMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #