Provider Demographics
NPI:1861468506
Name:KIMPEL, BEVERLY A (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:KIMPEL
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 1:149 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4974
Mailing Address - Country:US
Mailing Address - Phone:207-872-1303
Mailing Address - Fax:207-873-1302
Practice Address - Street 1:149 NORTH ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4974
Practice Address - Country:US
Practice Address - Phone:207-872-1303
Practice Address - Fax:207-872-1302
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016609207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME415650099Medicaid
MEME0876Medicare PIN
MESX4960Medicare PIN
MEP00351432Medicare PIN
MEE55686Medicare UPIN
MEP00430190Medicare PIN
MESX2693Medicare PIN