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General NPI Number Information
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NPI Number | 1497752588
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Entity Type | Individual
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Provider Name | THERESA MAE TILTON MD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 3021 WINDERMERE ROAD
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City | LEXINGTON
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State | KY
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Zip | 40502-2950
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Country | US
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Telephone | 859-278-5270
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Fax | 229-928-3492
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Provider Business Mailing Address
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Address Line | 23625 COMMERCE PARK SUITE 204
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City | BEACHWOOD
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State | OH
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Zip | 44122-5845
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Country | US
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Telephone | 216-255-5727
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Fax | 866-458-9875
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME74267
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 34103
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License Number State | KY
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