Provider Demographics
NPI:1316980022
Name:KIMMEL, ANDREW S (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OSTRUM ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1010
Mailing Address - Country:US
Mailing Address - Phone:484-526-3010
Mailing Address - Fax:484-526-3591
Practice Address - Street 1:800 OSTRUM ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1010
Practice Address - Country:US
Practice Address - Phone:484-526-3010
Practice Address - Fax:484-526-3591
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045462E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011944910001Medicaid
PA01204501OtherIND. CAPITAL BLUE CROSS #
PA55492OtherIND. HIGHMARK BLUE SHIELD
PA0011944910001Medicaid
PA055492ZWL7Medicare PIN