Provider Demographics
NPI:1144416231
Name:SMITH, KIMBERLY GAIL (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GAIL
Last Name:SMITH
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 1:670 LAWN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1571
Mailing Address - Country:US
Mailing Address - Phone:215-257-0414
Mailing Address - Fax:
Practice Address - Street 1:670 LAWN AVE STE 4
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1571
Practice Address - Country:US
Practice Address - Phone:215-257-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190708207V00000X
PAMD442845207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology