Provider Demographics
NPI:1770524050
Name:GINYARD, KIMBERLY MICHELE (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:GINYARD
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 1:117 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1252
Mailing Address - Country:US
Mailing Address - Phone:315-493-3100
Mailing Address - Fax:315-493-3113
Practice Address - Street 1:117 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1252
Practice Address - Country:US
Practice Address - Phone:315-493-3100
Practice Address - Fax:315-493-3113
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205519207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH14471Medicare UPIN
NY630D51Medicare ID - Type Unspecified