Basic Information
| Provider Information | |||||||||
| NPI: | 1316961683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | D'AMORE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 198 PARRISH ST | ||||||||
| Address2: | |||||||||
| City: | CANANDAIGUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144241729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853931550 | ||||||||
| FaxNumber: | 5853949089 | ||||||||
| Practice Location | |||||||||
| Address1: | 198 PARRISH ST | ||||||||
| Address2: | |||||||||
| City: | CANANDAIGUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144241729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853931550 | ||||||||
| FaxNumber: | 5853949089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 209611 | NY | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01868331 | 05 | NY | MEDICAID |