Provider Demographics
NPI:1073534665
Name:MEAD-WALTERS, KIMBERELY LYNN (MD,)
Entity Type:Individual
Prefix:
First Name:KIMBERELY
Middle Name:LYNN
Last Name:MEAD-WALTERS
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 OLD COLONY WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-3278
Mailing Address - Country:US
Mailing Address - Phone:508-240-1141
Mailing Address - Fax:
Practice Address - Street 1:81 OLD COLONY WAY
Practice Address - Street 2:SUITE D
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3278
Practice Address - Country:US
Practice Address - Phone:508-240-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3150968Medicaid
MA3150968Medicaid
A20917Medicare ID - Type Unspecified