Provider Demographics
NPI:1255307591
Name:KIMMEL, CRAIG S (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1761
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-796-9397
Practice Address - Street 1:1 BRACE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-470-9029
Practice Address - Fax:856-428-4053
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2013-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05473800207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2223902Medicaid
NJ2223902Medicaid