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General NPI Number Information
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NPI Number | 1700215043
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Entity Type | Organization
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Legal Business Name | KILBY PEDIATRICS, LLC
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 191 SHARP ROCK RD
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City | SPERRYVILLE
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State | VA
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Zip | 22740-2346
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Country | US
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Telephone | 540-987-9508
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Fax | 540-987-9508
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Provider Business Mailing Address
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Address Line | 191 SHARP ROCK RD
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City | SPERRYVILLE
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State | VA
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Zip | 22740-2346
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Country | US
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Telephone | 540-987-9508
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Fax | 540-987-9508
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALTER B. KILBY
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Credential | M.D.
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Telephone | 540-987-9508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101019886
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License Number State | VA
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