Provider Demographics
NPI:1265404883
Name:GORING, KIM LESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:LESLEY
Last Name:GORING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6946 NEWBERRY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4255
Mailing Address - Country:US
Mailing Address - Phone:443-542-9432
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-6821
Practice Address - Country:US
Practice Address - Phone:202-865-6280
Practice Address - Fax:202-865-1014
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD56571207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCH69898Medicare UPIN