MEDICARE: KIMBERELY LYNN MEAD-WALTERS M.D,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	150202	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073534665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERELY LYNN MEAD-WALTERS M.D,

Provider Business Mailing Address
First Line	:	81 OLD COLONY WAY
Second Line	:	SUITE D
City	:	ORLEANS
State	:	MA
Zip	:	02653-3278
Country	:	US
Telephone Number	:	508-240-1141
Fax Number	:

Provider Business Practice Location Address
First Line	:	81 OLD COLONY WAY
Second Line	:	SUITE D
City	:	ORLEANS
State	:	MA
Zip	:	02653-3278
Country	:	US
Telephone Number	:	508-240-1141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	12/06/2013

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