Provider Demographics
NPI:1720192545
Name:KIMMEY, GERRIT ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:GERRIT
Middle Name:ANTHONY
Last Name:KIMMEY
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 1:5170 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2004
Mailing Address - Country:US
Mailing Address - Phone:304-528-4645
Mailing Address - Fax:304-697-0807
Practice Address - Street 1:5170 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2004
Practice Address - Country:US
Practice Address - Phone:304-528-4645
Practice Address - Fax:304-697-0807
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13870207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0084318000Medicaid
OH0589126Medicaid
KY6407176Medicaid
KY6407176Medicaid
WV900001007Medicare ID - Type UnspecifiedRAILROAD MEDICARE
E87171Medicare UPIN