Individual
TERESA MARY KILGORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
279
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002794
—
SC
01
—
110234017
MEDICARE RAILROAD
SC
01
—
57-6007863
BCBS
SC
01
—
576007863
AETNA
SC
Enumeration date
09/20/2006
Last updated
03/07/2023
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