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General NPI Number Information
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NPI Number | 1184006835
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Entity Type | Individual
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Provider Name | KIERA LYN BOOTH MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 537 STANTON CHRISTIANA RD STE 207
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City | NEWARK
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State | DE
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Zip | 19713-2148
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Country | US
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Telephone | 302-633-7550
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 W MICHIGAN ST # CL626
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5209
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Country | US
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Telephone |
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD466761
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License Number State | PA
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