Provider Demographics
NPI:1831174986
Name:PILCHARD, KIRSTIN MARION (MD)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:MARION
Last Name:PILCHARD
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:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-0786
Mailing Address - Country:US
Mailing Address - Phone:860-364-0226
Mailing Address - Fax:860-364-0875
Practice Address - Street 1:21 ELM ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2915
Practice Address - Country:US
Practice Address - Phone:860-210-5002
Practice Address - Fax:860-210-5003
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040837208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001408378Medicaid
CT001408378Medicaid
CT020001541Medicare ID - Type Unspecified