Healthcare Provider Details

I. General information

NPI: 1386652113
Provider Name (Legal Business Name): SARA B KINSMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MARKET ST CHOP CARE NETWORK AT MARKET ST.
PHILADELPHIA PA
19104-3329
US

IV. Provider business mailing address

100 N 20TH ST SUITE 301
PHILADELPHIA PA
19103-1443
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3537
  • Fax:
Mailing address:
  • Phone: 215-567-2422
  • Fax: 215-561-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD048972L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD048972L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: