Individual
THERESA MAE TILTON
Active
Individual
THERESA MAE TILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
34103
KY
2085R0202X
Diagnostic Radiology Physician
ME74267
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03083272
—
NY
05
—
221123800
—
MD
05
—
263513500
—
FL
01
—
300138462
RR
—
01
—
42591
BCBS
—
05
—
488628
—
AZ
05
—
64927270
—
KY
05
—
808323500
—
ID
01
—
P00922044
RXR MEDICARE
KY
Enumeration date
07/05/2005
Last updated
02/15/2012
Update your record
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