Healthcare Provider Details

I. General information

NPI: 1316961683
Provider Name (Legal Business Name): KIMBERLY J D'AMORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 PARRISH ST
CANANDAIGUA NY
14424-1729
US

IV. Provider business mailing address

198 PARRISH ST
CANANDAIGUA NY
14424-1729
US

V. Phone/Fax

Practice location:
  • Phone: 585-393-1550
  • Fax: 585-394-9089
Mailing address:
  • Phone: 585-393-1550
  • Fax: 585-394-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number209611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: