Provider Demographics
NPI:1184874208
Name:VOGELSANG, KIMBERLY ANNE (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:VOGELSANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:VOGELSANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:220 LINDEN OAKS
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2839
Mailing Address - Country:US
Mailing Address - Phone:585-381-4982
Mailing Address - Fax:585-381-1821
Practice Address - Street 1:220 LINDEN OAKS
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2839
Practice Address - Country:US
Practice Address - Phone:585-381-4982
Practice Address - Fax:585-381-1821
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249645208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3257458Medicaid