Provider Demographics
NPI:1790777589
Name:EBB, KIMBERLY W (MD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:W
Last Name:EBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:50 MEMORIAL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-2277
Practice Address - Fax:978-466-2282
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151001207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA49154OtherFALLON
66455OtherHARVARD
MA3174671Medicaid
MA151001OtherTUFTS
MA3174671Medicaid
MA151001OtherTUFTS