Provider Demographics
NPI:1558549055
Name:KIM M ABDALLA
Entity Type:Organization
Organization Name:KIM M ABDALLA
Other - Org Name:DR. KIM MARIE DIGIACOMO
Other - Org Type:Other Name
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DI GIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-343-2800
Mailing Address - Street 1:2370 YORK RD
Mailing Address - Street 2:SUITE D2
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1031
Mailing Address - Country:US
Mailing Address - Phone:215-343-2800
Mailing Address - Fax:215-491-1750
Practice Address - Street 1:2370 YORK RD
Practice Address - Street 2:SUITE D2
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1031
Practice Address - Country:US
Practice Address - Phone:215-343-2800
Practice Address - Fax:215-491-1750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMISON FOOT AND ANKLE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-06
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003199L332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA447982Other447982
PAU12514Medicare UPIN
1253180001Medicare NSC