Provider Demographics
NPI:1306812664
Name:DAVIS, KIMBERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:DAVIS
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 1:330 CEDAR ST
Mailing Address - Street 2:BB310 - SECTION OF TRAUMA, DEPARTMENT OF SURGERY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8062
Mailing Address - Country:US
Mailing Address - Phone:203-785-2572
Mailing Address - Fax:203-785-3950
Practice Address - Street 1:330 CEDAR ST
Practice Address - Street 2:BB310 - SECTION OF TRAUMA, DEPARTMENT OF SURGERY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8062
Practice Address - Country:US
Practice Address - Phone:203-785-2572
Practice Address - Fax:203-785-3950
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36097831208600000X, 2086S0102X
CT044142208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57610Medicare UPIN
ILL81031Medicare ID - Type Unspecified
IL493320Medicare ID - Type Unspecified