Provider Demographics
NPI:1386878155
Name:KIRTLAND, DAVID RAND (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAND
Last Name:KIRTLAND
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 1:100 E CAMPUS VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4647
Mailing Address - Country:US
Mailing Address - Phone:614-340-7747
Mailing Address - Fax:
Practice Address - Street 1:100 E CAMPUS VIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4647
Practice Address - Country:US
Practice Address - Phone:614-340-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1226542085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810029055Medicaid
OH0123639Medicaid
OHP01604261OtherRAILROAD MEDICARE - MHCPI
OHP01604261OtherRAILROAD MEDICARE - MHCPI
OHH303530Medicare PIN