Provider Demographics
NPI:1255390480
Name:VORE, KIMBERLE KELLER (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLE
Middle Name:KELLER
Last Name:VORE
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 1:95 LEONARD AVE
Mailing Address - Street 2:BLDG 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3368
Mailing Address - Country:US
Mailing Address - Phone:724-223-3100
Mailing Address - Fax:724-223-3353
Practice Address - Street 1:95 LEONARD AVE
Practice Address - Street 2:BLDG 2
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3368
Practice Address - Country:US
Practice Address - Phone:724-223-3100
Practice Address - Fax:724-223-3353
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039745E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000512787OtherHIGHMARK
PA0011876390003Medicaid
63904OtherUNISON
P000416OtherGATEWAY
102749OtherUPMC
E98994Medicare UPIN
63904OtherUNISON
080075952Medicare PIN