Provider Demographics
NPI:1700904000
Name:CIRKSENA, WILLIAM JOHN SR (M D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:CIRKSENA
Suffix:SR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 COACHWAY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6416
Mailing Address - Country:US
Mailing Address - Phone:410-849-2411
Mailing Address - Fax:410-849-2431
Practice Address - Street 1:813 COACHWAY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-6416
Practice Address - Country:US
Practice Address - Phone:410-849-2411
Practice Address - Fax:410-849-2431
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0001228207RN0300X
HIMD-11413207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB68952Medicare UPIN