Provider Demographics
NPI:1659365641
Name:GOOCH, KIMBERLY K (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:K
Last Name:GOOCH
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 1:115 MT BLUE CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6239
Mailing Address - Country:US
Mailing Address - Phone:207-778-9664
Mailing Address - Fax:207-778-5913
Practice Address - Street 1:115 MT BLUE CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6239
Practice Address - Country:US
Practice Address - Phone:207-778-9664
Practice Address - Fax:207-778-5913
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME11474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
015366Medicare ID - Type Unspecified
B86581Medicare UPIN