Provider Demographics
NPI:1558692277
Name:MOFFAT, KIMBERLY MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARY
Last Name:MOFFAT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-7850
Practice Address - Fax:570-808-7855
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2014-07-16
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Provider Licenses
StateLicense IDTaxonomies
PAMD437913207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology