Provider Demographics
NPI:1801864202
Name:STEGMAIER, KIMBERLY (MD)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:STEGMAIER
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 1:49 PRINCE STREET
Mailing Address - Street 2:#1
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-983-3943
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-4985
Practice Address - Fax:617-632-4850
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1600192080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160019OtherTUFTS
9483OtherHPHC DFCI ONLY
J24682OtherMA BLUE CROSS BLUE SHIELD
2938427OtherAETNA US HEALTHCARE
6849485OtherCIGNA
0191043OtherMASSHEALTH MA MEDICAID
53264OtherFALLON COMM HEALTH PLAN
53264OtherFALLON COMM HEALTH PLAN
H59867Medicare UPIN