Provider Demographics
NPI:1346244704
Name:ELMER, KIMBERLY KAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAROL
Last Name:ELMER
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 1:532 MOE RD
Mailing Address - Street 2:CLIFTON PARK
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3822
Mailing Address - Country:US
Mailing Address - Phone:518-383-2425
Mailing Address - Fax:518-383-3255
Practice Address - Street 1:532 MOE RD
Practice Address - Street 2:CLIFTON PARK
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3822
Practice Address - Country:US
Practice Address - Phone:518-383-2425
Practice Address - Fax:518-383-3255
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:2005-06-23
Deactivation Code:
Reactivation Date:2005-08-04
Provider Licenses
StateLicense IDTaxonomies
NY2000452080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00347562Medicaid
NYG16078Medicare UPIN
NY00347562Medicaid