Provider Demographics
NPI:1508156555
Name:PALACIOS-KIBLER, THAMIRIS V (DO)
Entity Type:Individual
Prefix:
First Name:THAMIRIS
Middle Name:V
Last Name:PALACIOS-KIBLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:THAMIRIS
Other - Middle Name:VALERIA
Other - Last Name:PALACIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2955 IVY RD STE 311
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-9353
Practice Address - Country:US
Practice Address - Phone:434-924-2227
Practice Address - Fax:434-243-7288
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102204623207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program