Individual
DR. KIM ANN RUTHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(717) 531-8955
Mailing address
259 1ST ST, MINEOLA, NY 11501-3957
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
37476
AZ
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
37476
AZ
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
MD417166
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001868391
—
PA
01
—
169184
MEDICARE
PA
Enumeration date
09/06/2007
Last updated
03/30/2021
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