Provider Demographics
NPI:1922214030
Name:KERRY KIRIFIDES, M.D., P.A.
Entity Type:Organization
Organization Name:KERRY KIRIFIDES, M.D., P.A.
Other - Org Name:JUST KIDS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIRIFIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-918-6400
Mailing Address - Street 1:875 AAA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3624
Mailing Address - Country:US
Mailing Address - Phone:302-918-6400
Mailing Address - Fax:302-918-6412
Practice Address - Street 1:875 AAA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3624
Practice Address - Country:US
Practice Address - Phone:302-918-6400
Practice Address - Fax:302-918-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2007216425208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty