Provider Demographics
NPI:1124077623
Name:VAN KIRK, MARION PERKINS (MD)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:PERKINS
Last Name:VAN KIRK
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 2300
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28793-2300
Mailing Address - Country:US
Mailing Address - Phone:828-693-1773
Mailing Address - Fax:828-692-3297
Practice Address - Street 1:1701 OLD VILLAGE RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3772
Practice Address - Country:US
Practice Address - Phone:828-693-1773
Practice Address - Fax:828-692-3297
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31671207W00000X
SC14077207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8984716Medicaid
NC8984716Medicaid
C86883Medicare UPIN
NC211131Medicare ID - Type UnspecifiedMEDICARE