Provider Demographics
NPI:1255517124
Name:LINGLER, KIMBERLEY SIERRA (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:SIERRA
Last Name:LINGLER
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 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-748-9071
Mailing Address - Fax:804-768-8626
Practice Address - Street 1:12801 IRON BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1669
Practice Address - Country:US
Practice Address - Phone:804-748-9071
Practice Address - Fax:804-768-8626
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1027Medicaid
NC5912250Medicaid
NC2075030Medicare PIN
SCNC1027Medicaid