Provider Demographics
NPI:1487621199
Name:DAVIES, KIMBERLY JAN (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JAN
Last Name:DAVIES
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 1:44 BINNEY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-4920
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA706662080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ10208OtherBCBS INDEMNITY ELECT HMO
23286OtherFALLON COMMUNITY HEALTH
MA3088812Medicaid
6563914OtherCIGNA
070666OtherTUFTS
2927581OtherAETNA US HEALTHCARE
E54939DFOtherHPHC DFCI ONLY
23286OtherFALLON COMMUNITY HEALTH
MA3088812Medicaid