Provider Demographics
NPI:1902860729
Name:TRINIDAD, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TRINIDAD
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 1:78 NEW AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3307
Mailing Address - Country:US
Mailing Address - Phone:716-876-0284
Mailing Address - Fax:
Practice Address - Street 1:200 STERLING DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1577
Practice Address - Country:US
Practice Address - Phone:716-218-1020
Practice Address - Fax:716-677-4038
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1893492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000523232010OtherBC OF WNY
NY0506775OtherIHA
NY01353355Medicaid
NY01353355Medicaid