Provider Demographics
NPI:1205808631
Name:KIMMEL, ROBERT MONROE (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MONROE
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E NORWEGIAN ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3711
Mailing Address - Country:US
Mailing Address - Phone:570-622-2900
Mailing Address - Fax:570-622-7787
Practice Address - Street 1:575 E NORWEGIAN ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3711
Practice Address - Country:US
Practice Address - Phone:570-622-2900
Practice Address - Fax:570-622-7787
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
PAMD048645L2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA769995Medicare ID - Type Unspecified
PAF80349Medicare UPIN