MEDICARE: DOUGLAS KIMMEL D.O.

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	207Q00000X	Family Medicine Physician	OS006506L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	570038	OTHER	PA	PA BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0391404000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
4	98765	OTHER	PA	AETNA US HEATLHCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891780631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS KIMMEL D.O.

Provider Business Mailing Address
First Line	:	1648 HUNTINGDON PIKE
Second Line	:	MEDICAL STAFF OFFICE 1ST FLR
City	:	MEADOWBROOK
State	:	PA
Zip	:	19046-8001
Country	:	US
Telephone Number	:	215-938-3450
Fax Number	:	215-938-3829

Provider Business Practice Location Address
First Line	:	23 BUSTLETON PIKE
Second Line	:	SUITE 100
City	:	FEASTERVILLE TREVOSE
State	:	PA
Zip	:	19053-6446
Country	:	US
Telephone Number	:	215-464-9599
Fax Number	:	215-464-7865

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/02/2021

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Directions to “ DOUGLAS KIMMEL D.O.” Practice Location

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