Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 34650 | NC |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 34650 | NC |
NPI | 1265500250 |
---|---|
Provider Name | Deanna Marie Kirchmayer |
First Address | Greensboro, NC 27401-1303 |
Second Address | Greensboro, NC 27401-1303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 22/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BK2860092 | DEA (01) | NC |
S17435 | (02) | NC |