Provider Demographics
NPI:1265427710
Name:KIRLIN, DAVID RUSSELL I (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSELL
Last Name:KIRLIN
Suffix:I
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 WILMOT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4048
Mailing Address - Country:US
Mailing Address - Phone:704-861-0425
Mailing Address - Fax:704-861-0274
Practice Address - Street 1:251 WILMOT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4048
Practice Address - Country:US
Practice Address - Phone:704-861-0425
Practice Address - Fax:704-861-0274
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC168213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1031002005OtherCIGNA
08114OtherBCBS
1031002OtherCIGNA
107026OtherWELLNESS
17606OtherWELLPATH
4406434OtherAETNA
561552247001OtherPRUDENTIAL
238687OtherMAMSI
662897OtherAETNA
10343OtherPARTNERS
NC8908114Medicaid
SCPDN168Medicaid
08114OtherBCBS
17606OtherWELLPATH
4406434OtherAETNA