Provider Demographics
NPI:1851448369
Name:CIAMPA-MAGGIO, KIM (OD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CIAMPA-MAGGIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:CIAMPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:33 BELMONT PL
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1713
Mailing Address - Country:US
Mailing Address - Phone:781-665-5781
Mailing Address - Fax:
Practice Address - Street 1:490 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3841
Practice Address - Country:US
Practice Address - Phone:781-665-0897
Practice Address - Fax:781-665-8828
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 3960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW16162OtherBLUE CROSS BLUE SHIELD MA
MA0712833Medicaid
MA9376017OtherCIGNA
MAU71669Medicare ID - Type Unspecified