Provider Demographics
NPI:1962765487
Name:KIBIROVA, ALBINA (MD)
Entity type:Individual
Prefix:
First Name:ALBINA
Middle Name:
Last Name:KIBIROVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 KIMBALL DR UNIT 125
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2623
Mailing Address - Country:US
Mailing Address - Phone:603-622-6484
Mailing Address - Fax:603-647-8593
Practice Address - Street 1:250 PLEASANT ST FL 2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-622-6484
Practice Address - Fax:603-647-8593
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17220207R00000X
WV390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3102755Medicaid