Provider Demographics
NPI:1639114119
Name:KIMBERLY MARONEY, M.D., P.A.
Entity Type:Organization
Organization Name:KIMBERLY MARONEY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-729-0133
Mailing Address - Street 1:400 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-4333
Mailing Address - Country:US
Mailing Address - Phone:361-729-0133
Mailing Address - Fax:361-729-0855
Practice Address - Street 1:400 ENTERPRISE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-4333
Practice Address - Country:US
Practice Address - Phone:361-729-0133
Practice Address - Fax:361-729-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00488TMedicare ID - Type Unspecified
TXH20778Medicare UPIN