Provider Demographics
NPI:1033278718
Name:WILLIAMS-PARK, KIMBERLEE J (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:J
Last Name:WILLIAMS-PARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KIMBERLEE
Other - Middle Name:J
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2476 SWEDESFORD RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1456
Mailing Address - Country:US
Mailing Address - Phone:844-902-2345
Mailing Address - Fax:
Practice Address - Street 1:2476 SWEDESFORD RD STE 150
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1456
Practice Address - Country:US
Practice Address - Phone:844-902-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008520L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA677472Medicare PIN
PAG43339Medicare UPIN