Provider Demographics
NPI:1467627711
Name:RONALD W KIMBALL M D P C
Entity Type:Organization
Organization Name:RONALD W KIMBALL M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-365-1113
Mailing Address - Street 1:1 WINGATE CT
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1117
Mailing Address - Country:US
Mailing Address - Phone:215-365-1113
Mailing Address - Fax:215-365-1114
Practice Address - Street 1:7701 LINDBERGH BLVD
Practice Address - Street 2:SUITE 713
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2132
Practice Address - Country:US
Practice Address - Phone:215-365-1113
Practice Address - Fax:215-365-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015251E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00065287900001Medicaid
PA00065287900001Medicaid
PA173570Medicare PIN