Provider Demographics
NPI:1992785125
Name:TRESCH, KIMBERLY M (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:TRESCH
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 1:228 BILLERICA RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3604
Mailing Address - Country:US
Mailing Address - Phone:978-250-6300
Mailing Address - Fax:978-250-6335
Practice Address - Street 1:228 BILLERICA RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3604
Practice Address - Country:US
Practice Address - Phone:978-250-6300
Practice Address - Fax:978-250-6335
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2096522080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0141941Medicaid
MAHV0047OtherHARVARD PILGRIM
MA209652OtherTUFTS
MAJ23947OtherBLUE CROSS
MA0023640OtherNEIGHBORHOOD HEALTH
MA0023640OtherNEIGHBORHOOD HEALTH
MAA33672Medicare ID - Type Unspecified