Individual
IRA N KIRSCHENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26 CITY HALL MALL, MEDFORD, MA 02155-4754
(781) 306-5100
(781) 306-5379
Mailing address
147 MILK ST, PROVIDER ENROLLMENT DEPARTMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 421-2508
(617) 421-3487
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
30357
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017155
NEIGHBORHOOD HEALTH
MA
05
—
0146749
—
MA
01
—
030357
TUFTS HEALTH PLAN
MD
01
—
300126057
RAILROAD
MA
01
—
6031309-001
CIGNA
MA
01
—
6031309-001
HEALTHSOURCE
MD
01
—
C04608
BLUE CROSS BLUE SHIELD
MA
01
—
R121
HARVARD PILGRIM
MA
Enumeration date
04/26/2006
Last updated
05/12/2011
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