Provider Demographics
NPI:1457385387
Name:PARENTE, KIMBERLY FOWLER (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FOWLER
Last Name:PARENTE
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 1:900 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-5408
Mailing Address - Country:US
Mailing Address - Phone:508-898-2338
Mailing Address - Fax:508-366-9938
Practice Address - Street 1:900 UNION ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-5408
Practice Address - Country:US
Practice Address - Phone:508-898-2338
Practice Address - Fax:508-366-9938
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161038208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110061679AMedicaid
MA3199053Medicaid
MA3199053Medicaid