Healthcare Provider Details

I. General information

NPI: 1750334371
Provider Name (Legal Business Name): KIMBERLY SCHOEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 PROVIDENCE HWY
DEDHAM MA
02026-1875
US

IV. Provider business mailing address

7 PARK PLACE
BOSTON MA
02130
US

V. Phone/Fax

Practice location:
  • Phone: 781-461-0200
  • Fax:
Mailing address:
  • Phone: 617-524-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number219214
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberG61335
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierJ27908
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBSMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: