Healthcare Provider Details

I. General information

NPI: 1205585403
Provider Name (Legal Business Name): DUNCAN JACK KIMMEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST RM 474
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

701 W PRATT ST RM 474
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6325
  • Fax:
Mailing address:
  • Phone: 410-328-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number343401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: