Provider Demographics
NPI:1366495871
Name:DONALDSON, KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:DONALDSON
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 1:19 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:GLEN GARDNER
Mailing Address - State:NJ
Mailing Address - Zip Code:08826-3009
Mailing Address - Country:US
Mailing Address - Phone:908-803-7117
Mailing Address - Fax:
Practice Address - Street 1:185 ROSEBERRY ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1690
Practice Address - Country:US
Practice Address - Phone:908-859-6700
Practice Address - Fax:908-859-6812
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA071581207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0028479Medicaid