Provider Demographics
NPI:1992742191
Name:THORNTON, KIM L (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:L
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:130 2D AVENUE
Mailing Address - Street 2:BOSTON IVF - THE WALTHAM CENTER
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451
Mailing Address - Country:US
Mailing Address - Phone:781-434-6500
Mailing Address - Fax:781-434-6501
Practice Address - Street 1:130 2D AVENUE
Practice Address - Street 2:BOSTON IVF - THE WALTHAM CENTER
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451
Practice Address - Country:US
Practice Address - Phone:781-434-6500
Practice Address - Fax:781-434-6501
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153109207VE0102X, 207VG0400X
RIMD10471207VE0102X, 207VG0400X
CT029664207VE0102X, 207VG0400X
OH35.052652207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3088707Medicaid
CT160000976Medicare ID - Type Unspecified
MAA23528Medicare ID - Type Unspecified
MA3088707Medicaid