Provider Demographics
NPI:1013916436
Name:WORTHINGTON-KIRSCH, ROBERT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:WORTHINGTON-KIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 NORTHDALE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1871
Mailing Address - Country:US
Mailing Address - Phone:800-991-6117
Mailing Address - Fax:888-812-8191
Practice Address - Street 1:4619 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1329
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:888-812-8191
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-06-07
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
PAMD039322E2085R0204X
MDD00661032085R0204X
NJ25MA087622002085R0204X
WAMD601585212085R0204X
CAG887952085R0204X
GA0651992085R0204X
NC2011-001762085R0204X
DCMD0396562085R0204X
FLME1548792085R0204X
FLME1096362085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA609994V0UMedicare PIN
PAE55639Medicare UPIN
PA137760Medicare UPIN
PA609984YCYYMedicare UPIN
PA194873Medicare UPIN