Provider Demographics
NPI:1114033065
Name:KIMMEL, ALAN LEE (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:LEE
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8213 TALLY HO RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4718
Mailing Address - Country:US
Mailing Address - Phone:410-218-3691
Mailing Address - Fax:
Practice Address - Street 1:8213 TALLY HO RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4718
Practice Address - Country:US
Practice Address - Phone:410-218-3691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4950Medicare PIN
C49241Medicare UPIN