Provider Demographics
NPI:1982640793
Name:PASQUALE, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PASQUALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PASQUALE-NIEBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5187
Mailing Address - Country:US
Mailing Address - Phone:757-547-9714
Mailing Address - Fax:757-547-0725
Practice Address - Street 1:500 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5187
Practice Address - Country:US
Practice Address - Phone:757-547-9714
Practice Address - Fax:757-547-0725
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231986207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H21032Medicare UPIN