Provider Demographics
NPI:1720132731
Name:VIRK, ALAMJIT (MD)
Entity type:Individual
Prefix:
First Name:ALAMJIT
Middle Name:
Last Name:VIRK
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 1:233 WORTHEN RD EAST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421
Mailing Address - Country:US
Mailing Address - Phone:781-858-8340
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL ROAD
Practice Address - Street 2:MARTHA'S VINEYARD HOSPITAL
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557
Practice Address - Country:US
Practice Address - Phone:508-957-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75933207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ13009OtherBLUE SHIELD
MA3096351Medicaid
MAF12805Medicare UPIN
MAF12805Medicare UPIN