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General NPI Number Information
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NPI Number | 1174721138
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Entity Type | Individual
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Provider Name | KIMBERLEY D RUTHERFORD MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 599 FARMINGTON AVE STE 102
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City | FARMINGTON
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State | CT
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Zip | 06032-2383
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Country | US
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Telephone | 860-284-4950
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Fax | 860-284-4951
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Provider Business Mailing Address
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Address Line | 599 FARMINGTON AVE STE 102
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City | FARMINGTON
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State | CT
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Zip | 06032-2383
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Country | US
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Telephone | 860-284-4950
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Fax | 860-284-4951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 256192
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 54829
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 54829
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 54829
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License Number State | CT
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