Healthcare Provider Details

I. General information

NPI: 1710185590
Provider Name (Legal Business Name): KIMBERLY PARSONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD STE M975
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax: 215-590-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD431996
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD431996
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: