Provider Demographics
NPI:1154594117
Name:KIRBACH, PETER D (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:KIRBACH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5228
Mailing Address - Country:US
Mailing Address - Phone:207-783-2039
Mailing Address - Fax:207-782-0184
Practice Address - Street 1:540 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5228
Practice Address - Country:US
Practice Address - Phone:207-783-2039
Practice Address - Fax:207-782-0184
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002273402Medicare PIN