Provider Demographics
NPI:1194759936
Name:KIRSCH, MARJORIE EMERY (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:EMERY
Last Name:KIRSCH
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 2745
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32316-2745
Mailing Address - Country:US
Mailing Address - Phone:850-606-8150
Mailing Address - Fax:850-487-7954
Practice Address - Street 1:2965 MUNICIPAL WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304
Practice Address - Country:US
Practice Address - Phone:850-606-8150
Practice Address - Fax:850-487-7954
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051563208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11192ZMedicare PIN
E65801Medicare UPIN