Provider Demographics
NPI:1912975244
Name:BIRD, KIMBERLY H (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:BIRD
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:VA
Mailing Address - Zip Code:24465-0490
Mailing Address - Country:US
Mailing Address - Phone:540-468-3300
Mailing Address - Fax:540-465-3301
Practice Address - Street 1:120 JACKSON RIVER ROAD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:VA
Practice Address - Zip Code:24465
Practice Address - Country:US
Practice Address - Phone:540-468-3300
Practice Address - Fax:540-468-3301
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004734H17Medicare PIN
G28898Medicare UPIN