Provider Demographics
NPI:1780624346
Name:KIRCHDOERFER, ELAINE J (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:J
Last Name:KIRCHDOERFER
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 1:731 W CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2419
Mailing Address - Country:US
Mailing Address - Phone:610-444-7550
Mailing Address - Fax:
Practice Address - Street 1:731 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2419
Practice Address - Country:US
Practice Address - Phone:610-444-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5916451OtherAETNA
WV0053378000Medicaid
PA103103434-0001Medicaid
WV001719914OtherMS BCBS
WV080040188OtherRR MEDICARE
PA103103434-0002Medicaid
WV2029313Medicare PIN
WV2029312Medicare PIN
WV001719914OtherMS BCBS
WV080040188OtherRR MEDICARE
WV2029311Medicare PIN