Provider Demographics
NPI:1104969708
Name:KIRBY, ANTHONY J (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
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 1:55 GOSAI DR STE 112
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-1061
Mailing Address - Country:US
Mailing Address - Phone:412-226-6399
Mailing Address - Fax:724-239-2167
Practice Address - Street 1:55 GOSAI DR
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1061
Practice Address - Country:US
Practice Address - Phone:412-226-6399
Practice Address - Fax:412-226-6399
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4363812081P2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2091008OtherHIGHMARK BLUE SHIELD
PA1102278777-0001Medicaid
PA1398027OtherHIGHMARK BLUE SHIELD
PA155484QU6Medicare PIN
PA060201Medicare PIN