Healthcare Provider Details

I. General information

NPI: 1255307591
Provider Name (Legal Business Name): CRAIG S. KIMMEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE ROAD SUITE B
CHERRY HILL NJ
08034
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1761
US

V. Phone/Fax

Practice location:
  • Phone: 856-470-9029
  • Fax: 856-428-4053
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-796-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MA05473800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: