Basic Information
| Provider Information | |||||||||
| NPI: | 1245305598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRBY | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O BOX 601043 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192338585 | ||||||||
| FaxNumber: | 9192338566 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 ASHVILLE AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275188682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192338585 | ||||||||
| FaxNumber: | 9192338566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 01/07/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 34371 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 135PC | 01 | NC | BCBS | OTHER | 34371 | 01 | NC | STATE LICENSE | OTHER | 89135PC | 05 | NC | MEDICAID | 561856695 | 01 | NC | TAX ID | OTHER |