MEDICARE: KILBY PEDIATRICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101019886	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0101019886	OTHER	VA	LICENSE

General Provider Information

NPI Number	:	1700215043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KILBY PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	191 SHARP ROCK RD
Second Line	:
City	:	SPERRYVILLE
State	:	VA
Zip	:	22740-2346
Country	:	US
Telephone Number	:	540-987-9508
Fax Number	:	540-987-9508

Provider Business Practice Location Address
First Line	:	191 SHARP ROCK RD
Second Line	:
City	:	SPERRYVILLE
State	:	VA
Zip	:	22740-2346
Country	:	US
Telephone Number	:	540-987-9508
Fax Number	:	540-987-9508

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WALTER B. KILBY
Credential	:	M.D.
Telephone Number	:	540-987-9508

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	11/07/2013

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