Provider Demographics
NPI:1942377296
Name:KIRCHNER, LUCILLE I (MD)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:I
Last Name:KIRCHNER
Suffix:
Gender:F
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:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058
Mailing Address - Country:US
Mailing Address - Phone:541-296-7668
Mailing Address - Fax:541-296-6431
Practice Address - Street 1:1825 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058
Practice Address - Country:US
Practice Address - Phone:541-506-6940
Practice Address - Fax:541-296-2636
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022974E207R00000X
ORMD154409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
153454OtherHIGH MARK
PA153454OtherBLUE SHIELD
OR218105Medicaid
110218192OtherRR MEDICARE
205080OtherUPMC
PA0008128290009Medicaid
OR383993Medicare Oscar/Certification
KI153454Medicare ID - Type Unspecified
PA0008128290009Medicaid
PA153454ZC4DMedicare PIN