Provider Demographics
NPI:1124139373
Name:SALENE, KIMBERLY J (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:SALENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2215 CANTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7301
Mailing Address - Country:US
Mailing Address - Phone:910-762-4600
Mailing Address - Fax:910-762-9483
Practice Address - Street 1:2215 CANTERWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7301
Practice Address - Country:US
Practice Address - Phone:910-762-4600
Practice Address - Fax:910-762-9483
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76181207R00000X
VA0101238899207R00000X
FL113939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
018611U11Medicare ID - Type Unspecified
I48248Medicare UPIN