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NPI Code Detail

MEDICARE: KINSHASA D KILGORE PA

MEDICARE: KINSHASA D KILGORE PA
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
1363A00000XPhysician AssistantPA06008TX
2390200000XStudent in an Organized Health Care Education/Training Program
3363A00000XPhysician AssistantC05240MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18Y8981OTHERTXBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740432814
Entity Type Code : Individual
Provider Name (Legal Business Name) : KINSHASA D KILGORE PA
Provider Business Mailing Address
First Line : 4601 MARTIN LUTHER KING JR AVE SW
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-1131
Country : US
Telephone Number : 571-249-3487
Fax Number :
Provider Business Practice Location Address
First Line : 2131 DAVIDSONVILLE RD
Second Line :
City : CROFTON
State : MD
Zip : 21114-1632
Country : US
Telephone Number : 410-721-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2008
Last Update Date : 02/13/2024

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Directions to “ KINSHASA D KILGORE PA” Practice Location

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