Healthcare Provider Details

I. General information

NPI: 1689761421
Provider Name (Legal Business Name): KIMBERLY RAWLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 BEACON ST
BROOKLINE MA
02446-4808
US

IV. Provider business mailing address

PO BOX 700 C/O CUSTOM MEDICAL BILLING INC 50 WEST MAIN STREET
AYER MA
01432-1233
US

V. Phone/Fax

Practice location:
  • Phone: 617-834-2092
  • Fax: 978-287-5566
Mailing address:
  • Phone: 978-772-7895
  • Fax: 978-772-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number55146
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: