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General NPI Number Information
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NPI Number | 1417095522
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Entity Type | Individual
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Provider Name | THOMAS RUSSELL KITCHENS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1507 WESTOVER TER SUITE A
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City | GREENSBORO
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State | NC
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Zip | 27408-7130
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Country | US
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Telephone | 336-373-0566
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Fax | 336-373-0667
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Provider Business Mailing Address
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Address Line | 1507 WESTOVER TER SUITE A
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City | GREENSBORO
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State | NC
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Zip | 27408-7130
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Country | US
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Telephone | 336-373-0566
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Fax | 336-373-0667
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 21284
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 21284
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License Number State | NC
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