Provider Demographics
NPI:1144225657
Name:BALDOCK, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BALDOCK
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 1:1816 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7643
Mailing Address - Country:US
Mailing Address - Phone:606-920-9595
Mailing Address - Fax:606-920-9605
Practice Address - Street 1:1816 CARTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7643
Practice Address - Country:US
Practice Address - Phone:606-920-9595
Practice Address - Fax:606-920-9605
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000689129OtherANTHEM BCBS
OH0206342Medicaid
KY64304728Medicaid
OH0206342Medicaid
KY64304728Medicaid
KY1605002Medicare PIN