Provider Demographics
NPI:1548214026
Name:FOEHL, KIM LIPONIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LIPONIS
Last Name:FOEHL
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 1:458 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2127
Mailing Address - Country:US
Mailing Address - Phone:617-795-5996
Mailing Address - Fax:
Practice Address - Street 1:3 CONCORD AVE APT 5
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3616
Practice Address - Country:US
Practice Address - Phone:617-795-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA547872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ06365Medicare ID - Type Unspecified
MAA59098Medicare UPIN