Provider Demographics
NPI:1437714201
Name:LAMIMAN, KELLY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:LAMIMAN
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 1:450 CLARKSON AVENUE
Mailing Address - Street 2:DIVISION OF GYNECOLOGIC ONCOLOGY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2012
Mailing Address - Country:US
Mailing Address - Phone:718-270-2081
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVENUE
Practice Address - Street 2:DIVISION OF GYNECOLOGIC ONCOLOGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10068530207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology