Provider Demographics
NPI:1083879753
Name:NURICK, KIM (DO)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:NURICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:NURICK
Other - Last Name:TARNOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:118 CHARLESTOWN HUNT DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2813
Mailing Address - Country:US
Mailing Address - Phone:610-935-8178
Mailing Address - Fax:
Practice Address - Street 1:118 CHARLESTOWN HUNT DR
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2813
Practice Address - Country:US
Practice Address - Phone:610-935-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006589-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine