1982643029 NPI number — DR. KIMBERLY E MCDERMOTT AU.D.

Table of content: DR. KIMBERLY E MCDERMOTT AU.D. (NPI 1982643029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982643029 NPI number — DR. KIMBERLY E MCDERMOTT AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDERMOTT
Provider First Name:
KIMBERLY
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHARP
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AU.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982643029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 LONG POND RD
Provider Second Line Business Mailing Address:
SUITE 251
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14626-1177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-225-1100
Provider Business Mailing Address Fax Number:
585-225-1112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 LONG POND RD
Provider Second Line Business Practice Location Address:
SUITE 251
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14626-1177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-225-1100
Provider Business Practice Location Address Fax Number:
585-225-1112
Provider Enumeration Date:
06/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  5470214UPD , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 14000018933 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7102000NY14626 . This is a "BC/BS OF MICHIGAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161406A1 . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".