Provider Demographics
NPI:1003813536
Name:KIM, MARILYN S (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1177 BOSTON PROVIDENCE TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5019
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-278-5667
Practice Address - Street 1:1177 BOSTON PROVIDENCE TPKE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5019
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5664
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-03-07
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Provider Licenses
StateLicense IDTaxonomies
MA77523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110145403OtherRAILROAD MEDICARE
761489OtherTUFTS BENEFIT ADMINISTRAT
116047OtherNEIGHBORHOOD HEALTH PLAN
3118525OtherMASS HEALTH DIV OF MED SV
761489OtherTUFTS
761489OtherTUFTS COMMONWEALTH PPO
761489OtherTUFTS TOTAL HEALTH PLAN
62131OtherHARVARD PILGRIMPPO
0410132OtherUNITED HEALTHCARE
27576OtherCHILDRENS MEDICAL SECURIT
4877330OtherCIGNA HEALTH CARE
62131OtherHARVARD PILGRIM POS
J14303OtherBS BLUE CARE ELECT
J14303OtherBLUE SHIELD INDEMNITY
62131OtherHARVARD PILGRIM
E72131OtherFIRST SENIORITY
MA4877330OtherHEALTHSOURCE
J14303OtherHMO BLUE BLUE CHOICE
761489OtherTUFTS COMMONWEALTH PPO
J14303Medicare ID - Type Unspecified