Individual
THERESA MAE TILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3021 WINDERMERE ROAD, LEXINGTON, KY 40502-2950
(859) 278-5270
(229) 928-3492
Mailing address
23625 COMMERCE PARK, SUITE 204, BEACHWOOD, OH 44122-5845
(216) 255-5727
(866) 458-9875
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
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