Provider Demographics
NPI:1669422028
Name:GIBSON-BERRY, KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:GIBSON-BERRY
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 1:3142B MOUNT MORRIS GENESEO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-9710
Mailing Address - Country:US
Mailing Address - Phone:585-658-2090
Mailing Address - Fax:585-658-4931
Practice Address - Street 1:3142B MOUNT MORRIS GENESEO RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-9710
Practice Address - Country:US
Practice Address - Phone:585-658-2090
Practice Address - Fax:585-658-4931
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB9277Medicare PIN