Provider Demographics
NPI:1528038684
Name:DEBNATH, KIRAN S (MD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:S
Last Name:DEBNATH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3200 TYRE NECK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3329
Mailing Address - Country:US
Mailing Address - Phone:757-399-7451
Mailing Address - Fax:757-399-1158
Practice Address - Street 1:3200 TYRE NECK RD STE 101
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703
Practice Address - Country:US
Practice Address - Phone:757-399-7451
Practice Address - Fax:757-399-1158
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101031216207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005749506Medicaid
VA050000747Medicare ID - Type Unspecified
VA005749506Medicaid