Basic Information
Provider Information
NPI: 1083788525
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIRCHGESSNER
FirstName: JOHN
MiddleName: C.
NamePrefix:  
NameSuffix:  
Credential: N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 RAY C HUNT DR
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229032981
CountryCode: US
TelephoneNumber: 4349806140
FaxNumber: 4349724266
Practice Location
Address1: UVA PRIMARY CARE CTR
Address2: LEE STREET, 2ND FLOOR
City: CHARLOTTESVILLE
State: VA
PostalCode: 229080001
CountryCode: US
TelephoneNumber: 4349249144
FaxNumber: 4349242940
Other Information
ProviderEnumerationDate: 11/17/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200X0024105522VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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