Provider Demographics
NPI:1700311248
Name:KIM, MEREDITH (MD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:PASMANTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1201 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3105
Mailing Address - Country:US
Mailing Address - Phone:203-597-9100
Mailing Address - Fax:
Practice Address - Street 1:1201 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3105
Practice Address - Country:US
Practice Address - Phone:203-597-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308719207W00000X
390200000X
CT73884207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty