Provider Demographics
NPI:1174721138
Name:RUTHERFORD, KIMBERLEY D (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:D
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 FARMINGTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2383
Mailing Address - Country:US
Mailing Address - Phone:860-284-4950
Mailing Address - Fax:860-284-4951
Practice Address - Street 1:599 FARMINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2383
Practice Address - Country:US
Practice Address - Phone:860-284-4950
Practice Address - Fax:860-284-4951
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256192207Y00000X
CT54829207YS0123X, 207YX0905X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery