Individual
DOUGLAS KIMMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
23 BUSTLETON PIKE, SUITE 100, FEASTERVILLE TREVOSE, PA 19053-6446
(215) 464-9599
(215) 464-7865
Mailing address
1648 HUNTINGDON PIKE, MEDICAL STAFF OFFICE 1ST FLR, MEADOWBROOK, PA 19046-8001
(215) 938-3450
(215) 938-3829
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS006506L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01767OS006506L
—
PA
01
—
0391404000
KEYSTONE HEALTH PLAN EAST
PA
05
—
100416C
—
PA
01
—
570038
PA BLUE SHIELD
PA
01
—
98765
AETNA US HEATLHCARE
PA
Enumeration date
09/19/2005
Last updated
07/02/2021
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