Provider Demographics
NPI:1235545963
Name:HADIAN, KIMBERLY M (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:HADIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERY
Other - Middle Name:
Other - Last Name:MCKENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25 PARK ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617
Mailing Address - Country:US
Mailing Address - Phone:315-379-9158
Mailing Address - Fax:
Practice Address - Street 1:2924 COUNTY ROUTE 17
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:NY
Practice Address - Zip Code:13630
Practice Address - Country:US
Practice Address - Phone:315-347-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290105-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine