Provider Demographics
NPI:1811981715
Name:KIRCHNER, SCOTT A (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:KIRCHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6555 CHIPPEWA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-4110
Mailing Address - Country:US
Mailing Address - Phone:314-645-8719
Mailing Address - Fax:314-645-8642
Practice Address - Street 1:6555 CHIPPEWA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-4110
Practice Address - Country:US
Practice Address - Phone:314-645-8719
Practice Address - Fax:314-645-8642
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2013-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR3C11207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BLC9364OtherBLUE CHOICE
10468OtherESSENCE
431269659OtherMISCELLANEOUS
5453OtherONE HEALTH
181250OtherHEALTHLINK
26D0438468OtherCLIA WAIVER
110005208OtherRAILROAD MEDICARE
3258644OtherPHCS HEALTH MARKET
9364OtherBLUE CROSS
A11500OtherMERCY HEALTH PLAN
0400231OtherUNITED HEALTHCARE
33594OtherGHP
A11500Medicare UPIN
33594OtherGHP