Healthcare Provider Details

I. General information

NPI: 1063489284
Provider Name (Legal Business Name): KIMBERLY CUOMO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY GLADE

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL STREET
SALISBURY MD
21801
US

IV. Provider business mailing address

100 E CARROLL STREET
SALISBURY MD
21801
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7536
  • Fax: 410-543-7272
Mailing address:
  • Phone: 410-543-7536
  • Fax: 410-543-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0054789
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: