Provider Demographics
NPI:1700861374
Name:GIBSON, KIM F (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:F
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:I
Other - Last Name:FRICKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5709 NEWINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1281
Mailing Address - Country:US
Mailing Address - Phone:301-275-2426
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:EXECUTIVE HEALTH, NNMC
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-8334
Practice Address - Fax:301-295-2433
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039533207R00000X
MDD0096709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine