Provider Demographics
NPI:1932293115
Name:KIRKWOOD, DAVID CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:KIRKWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2838 LINDEN AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-3049
Mailing Address - Country:US
Mailing Address - Phone:937-252-9965
Mailing Address - Fax:937-252-9927
Practice Address - Street 1:2838 LINDEN AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-3049
Practice Address - Country:US
Practice Address - Phone:937-252-9965
Practice Address - Fax:937-252-9927
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-0689K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0556134Medicaid
OH311178563OtherTAX ID
OHK10560783Medicare ID - Type Unspecified
OH0556134Medicaid