Individual
DR. KIMBERLY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
96 COLCHESTER AVE, BURLINGTON, VT 05401-1417
(802) 658-0505
Mailing address
96 COLCHESTER AVE, BURLINGTON, VT 05401-1417
(802) 658-0505
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
0420008805
VT
207V00000X
Obstetrics & Gynecology Physician
Primary
302048
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0VN0812
—
VT
01
—
160050512
RAIL ROAD MEDICARE
VT
Enumeration date
05/04/2006
Last updated
01/02/2020
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