Provider Demographics
NPI:1093834467
Name:KIRSCHNER, ELY A (MD)
Entity type:Individual
Prefix:
First Name:ELY
Middle Name:A
Last Name:KIRSCHNER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 CHESTNUT ST APT 26
Mailing Address - Street 2:
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1350
Mailing Address - Country:US
Mailing Address - Phone:617-584-9990
Mailing Address - Fax:
Practice Address - Street 1:1175 CHESTNUT ST APT 26
Practice Address - Street 2:
Practice Address - City:NEWTON UPPER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02464-1350
Practice Address - Country:US
Practice Address - Phone:617-584-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18134207Y00000X
MA34605207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A35092Medicare UPIN