Basic Information
Provider Information
NPI: 1417360009
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOWNING
FirstName: KIMBERLY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1500 LANSDOWNE AVE
Address2:  
City: DARBY
State: PA
PostalCode: 190231200
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1500 LANSDOWNE AVE
Address2:  
City: DARBY
State: PA
PostalCode: 190231200
CountryCode: US
TelephoneNumber: 6102374000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/11/2014
LastUpdateDate: 08/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XMD463207PAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


Home