Provider Demographics
NPI:1679657738
Name:KIMMICK, GRETCHEN (MD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:
Last Name:KIMMICK
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 1:2100 ERWIN RD
Mailing Address - Street 2:DUKE UNIVERSITY MEDICAL CENTER - DUMC 3204
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-668-0718
Mailing Address - Fax:
Practice Address - Street 1:2100 ERWIN RD DUMC BOX 3204
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-620-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35396207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2207883BMedicare ID - Type Unspecified
F98053Medicare ID - Type Unspecified
NC8948976Medicare ID - Type Unspecified