MEDICARE: KIMBERLY HOLLANDSWORTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	35068570	OH
2	207ZD0900X	Dermatopathology (Pathology) Physician	35068570	OH
3	207ND0900X	Dermatopathology Physician	35068570	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	606201	OTHER		BUCKEYE
3	000000221128	OTHER	OH	UNISON
4	000000523163	OTHER	OH	ANTHEM
5	5342550	OTHER	OH	AETNA
6	363644	OTHER	OH	WELLCARE

General Provider Information

NPI Number	:	1255316105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HOLLANDSWORTH MD

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVENUE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:	216-844-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/05/2011

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Directions to “ KIMBERLY HOLLANDSWORTH MD” Practice Location

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