Provider Demographics
NPI:1245280304
Name:KIMBER, ROGER GIRARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:GIRARD
Last Name:KIMBER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 TRACY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4854
Mailing Address - Country:US
Mailing Address - Phone:717-560-9879
Mailing Address - Fax:
Practice Address - Street 1:584 SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-9564
Practice Address - Country:US
Practice Address - Phone:717-354-4711
Practice Address - Fax:717-354-8830
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043511E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391941Medicare Oscar/Certification
PA391936Medicare Oscar/Certification
A72112Medicare UPIN
461976Medicare ID - Type Unspecified