Russell, Kimberly

Russell, Kimberly is an individual health care provider with primary practice located at 35 Pearl St Ste 100 , Brockton MA 02301-2866. She recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as her primary health care specialty. Russell, Kimberly can be contacted via phone (508) 588-8034.

Contact Information

Primary practice address
35 Pearl St Ste 100 Brockton MA 02301-2866
Fax: (508) 588-5969
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 269874 Massachusetts

Profile Details

NPI number 1326305905
LBN Legal business name Russell, Kimberly
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 19th, 2012
Last updated Apr 17th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326305905 NPPES
Massachusetts MEDICAID 110102733A

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