Provider Demographics
NPI:1982643029
Name:MCDERMOTT, KIMBERLY E (AUD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:E
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:E
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1100 LONG POND RD
Mailing Address - Street 2:SUITE 251
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1177
Mailing Address - Country:US
Mailing Address - Phone:585-225-1100
Mailing Address - Fax:585-225-1112
Practice Address - Street 1:1100 LONG POND RD
Practice Address - Street 2:SUITE 251
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1177
Practice Address - Country:US
Practice Address - Phone:585-225-1100
Practice Address - Fax:585-225-1112
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5470214UPD174400000X
NY14000018933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7102000NY14626OtherBC/BS OF MICHIGAN
NY161406A1OtherPREFERRED CARE
NY161406A1OtherPREFERRED CARE