1609958602 NPI number — ANN MARIE KIDD PNP

Table of content: ANN MARIE KIDD PNP (NPI 1609958602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609958602 NPI number — ANN MARIE KIDD PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIDD
Provider First Name:
ANN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609958602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 LINDEN OAKS SUITE 200
Provider Second Line Business Mailing Address:
PANORAMA PEDIATRICS GROUP RLLP
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-381-4982
Provider Business Mailing Address Fax Number:
585-381-1821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 LINDEN OAKS SUITE 200
Provider Second Line Business Practice Location Address:
PANORAMA PEDIATRICS GROUP RLLP
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-381-4982
Provider Business Practice Location Address Fax Number:
585-381-1821
Provider Enumeration Date:
10/19/2006

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: 363L00000X , with the licence number:  F3808121 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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