Provider Demographics
NPI:1063408581
Name:DEWEY, KIMBERLY ANNE (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:DEWEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1155
Mailing Address - Country:US
Mailing Address - Phone:413-599-1201
Mailing Address - Fax:413-596-2940
Practice Address - Street 1:2207 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1155
Practice Address - Country:US
Practice Address - Phone:413-599-1201
Practice Address - Fax:413-596-2940
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2206832080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
220683OtherMA LICENSE
MA2080303Medicaid
7034605OtherAETNA/USHC
220683OtherCONNECTICARE
AA16576OtherHARVARD PILGRIM
000000028542OtherBOSTON MED CENTER HEALTHN
1205530OtherUNITED HEALTHCARE
70513OtherCHILDRENS MEDICAL SECURIT
969421OtherNETWORK HEALTH
J27969OtherBCBS
34817OtherHEALTH NEW ENGLAND
34817OtherHEALTH NEW ENGLAND
A37431Medicare UPIN