Provider Demographics
NPI:1427069475
Name:KIRK, DEBORAH T (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:T
Last Name:KIRK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:T
Other - Last Name:NEUBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977
Mailing Address - Country:US
Mailing Address - Phone:302-653-6022
Mailing Address - Fax:302-389-1094
Practice Address - Street 1:100 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1373
Practice Address - Country:US
Practice Address - Phone:302-653-6022
Practice Address - Fax:302-389-1094
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100006527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000024655Medicaid
DE1000024655Medicaid
011815C05Medicare ID - Type Unspecified