Provider Demographics
NPI:1982645867
Name:KUBEK, KIMBERLY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:KUBEK
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 1:1222 MEADOWBANK RD
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-2106
Mailing Address - Country:US
Mailing Address - Phone:610-356-9030
Mailing Address - Fax:610-356-9036
Practice Address - Street 1:3475 W CHESTER PIKE
Practice Address - Street 2:SUITE 240
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4280
Practice Address - Country:US
Practice Address - Phone:610-356-9030
Practice Address - Fax:610-356-9036
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-030251-E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40707Medicare UPIN
PA175497Medicare ID - Type UnspecifiedMEDICAR PROVIDER ID