Basic Information
| Provider Information | |||||||||
| NPI: | 1093716417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORDE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 W HUNTING PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191291302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157078561 | ||||||||
| FaxNumber: | 2157073677 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191405103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157075067 | ||||||||
| FaxNumber: | 2157075126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD429502 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RI0008X | MD429502 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RT0003X | MD429502 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 0039732900 | 01 | FEDERAL BLACK LUNG BENEFITS | OTHER | 7362809 | 01 | AETNA / US HEALTHCARE | OTHER | 1194604 | 01 | AETNA/US HEALTHCARE HMO | OTHER | 407244800 | 01 | AMERIGROUP - AMERICAID | OTHER | 689LK994 | 01 | WELLCARE | OTHER | 131330 | 01 | JHHC | OTHER | 0003 | 01 | BCBS-DC | OTHER | 407244800 | 05 | MD | MEDICAID | 64615501 | 01 | BCBS-MD | OTHER |