Provider Demographics
NPI:1801885082
Name:KIRBY, RICHARD L (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 OLD OCEAN CITY BLVD
Mailing Address - Street 2:BUILDLING ONE
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1288
Mailing Address - Country:US
Mailing Address - Phone:410-629-6541
Mailing Address - Fax:410-629-1505
Practice Address - Street 1:10231 OLD OCEAN CITY BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3568
Practice Address - Country:US
Practice Address - Phone:410-629-6870
Practice Address - Fax:410-629-6541
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018053207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD188201500Medicaid
MD188201500Medicaid
MDD76520Medicare UPIN