Provider Demographics
NPI:1275504557
Name:LEGG-CORBA, KIMBERLY ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:LEGG-CORBA
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1150 GLENLIVET DR
Mailing Address - Street 2:STE A17
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106
Mailing Address - Country:US
Mailing Address - Phone:610-530-9155
Mailing Address - Fax:610-530-4495
Practice Address - Street 1:1150 GLENLIVET DR
Practice Address - Street 2:STE A17
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106
Practice Address - Country:US
Practice Address - Phone:610-530-9155
Practice Address - Fax:610-530-4495
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2007-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS 008453 L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080195420OtherPALMETTO GBA
PAF87264Medicare UPIN
PA412746RQMMedicare PIN