Provider Demographics
NPI:1265404883
Name:GORING, KIM LESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:LESLEY
Last Name:GORING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:995 PRINCE FREDERICK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3199
Mailing Address - Country:US
Mailing Address - Phone:410-414-6185
Mailing Address - Fax:443-968-9205
Practice Address - Street 1:19801 OBSERVATION DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4070
Practice Address - Country:US
Practice Address - Phone:301-557-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2025-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD56571207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCH69898Medicare UPIN