=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710213285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIM M. CLABBERS, MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2009
-----------------------------------------------------
Last Update Date | 07/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 W MAPLE AVE
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-2820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-785-9788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 BATH RD SUITE 2F
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19007-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-785-9788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KIM M CLABBERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 215-785-9788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD063354L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------