Basic Information
| Provider Information | |||||||||
| NPI: | 1821072109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRKPATRICK | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683130 | ||||||||
| FaxNumber: | 5083683133 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 SUMMER ST | ||||||||
| Address2: | SUITE 290 N | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683130 | ||||||||
| FaxNumber: | 5083683133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 70386 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | AA2359 | 01 | HARVARD PILGRIM HLTHCARE | OTHER | J09324 | 01 | BLUE SHIELD HMO BLUE | OTHER | J09324 | 01 | MEDICARE B | OTHER | 3055655 | 01 | MEDICAID/WELFARE | OTHER | 784042 | 01 | MVP HEALTH CARE | OTHER | 26822 | 01 | HEALTHY START | OTHER | J09324 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | HLTHCARE VALUE MANAGEMENT | OTHER | 4008126 | 01 | AETNA/US HEALTHCARE | OTHER | 3055655 | 05 | MA | MEDICAID | 9900283 | 01 | FALLON COMM HEALTH PLAN | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 042472266 | 01 | PRIVATE HLTHCARE SYSTEMS | OTHER | 2500245 | 01 | EVERCARE | OTHER | J09324 | 01 | BLUE CARE ELECT | OTHER | 26822 | 01 | CHILDREN MED SECURIT PLAN | OTHER | 5560410 | 01 | CIGNA HEALTH PLAN | OTHER | 1060835 | 01 | FIRST HEALTH | OTHER |