Provider Demographics
NPI:1134380702
Name:KIMLIN, EDWARD JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:KIMLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11915 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2065
Mailing Address - Country:US
Mailing Address - Phone:301-942-4505
Mailing Address - Fax:301-942-4509
Practice Address - Street 1:11915 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2065
Practice Address - Country:US
Practice Address - Phone:301-942-4505
Practice Address - Fax:301-942-4509
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070302207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0070302OtherMD LICENSE
VA0101251540OtherVA LICENSE
VA0101251540OtherVA LICENSE