Provider Demographics
NPI:1245305598
Name:KIRBY, SUZANNE L (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:KIRBY
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:P.O BOX 601043
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1043
Mailing Address - Country:US
Mailing Address - Phone:919-233-8585
Mailing Address - Fax:919-233-8566
Practice Address - Street 1:300 ASHVILLE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8682
Practice Address - Country:US
Practice Address - Phone:919-233-8585
Practice Address - Fax:919-233-8566
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34371207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135PCOtherBCBS
NC34371OtherSTATE LICENSE
NC89135PCMedicaid
NC561856695OtherTAX ID
2164012AMedicare PIN
F01469Medicare UPIN
NC89135PCMedicaid
NCF01469Medicare UPIN