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General NPI Number Information
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NPI Number | 1891780631
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Entity Type | Individual
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Provider Name | DOUGLAS KIMMEL D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 23 BUSTLETON PIKE SUITE 100
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-6446
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Country | US
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Telephone | 215-464-9599
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Fax | 215-464-7865
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Provider Business Mailing Address
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Address Line | 1648 HUNTINGDON PIKE MEDICAL STAFF OFFICE 1ST FLR
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City | MEADOWBROOK
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State | PA
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Zip | 19046-8001
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Country | US
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Telephone | 215-938-3450
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Fax | 215-938-3829
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS006506L
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License Number State | PA
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