Provider Demographics
NPI:1114998804
Name:MCKILLION, PATRICK C (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:C
Last Name:MCKILLION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4144
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:ONE HOSPITAL DRIVE
Practice Address - Street 2:SUITE 306
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-522-4144
Practice Address - Fax:570-768-3911
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091216207RC0200X
PAMD044372E207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114998804Medicaid
MIMI2051020Medicare UPIN
NC4324690OtherAETNA
NC891032FMedicaid
NCD9325OtherMEDCOST
NC2035615Medicare ID - Type Unspecified
NCE22007Medicare UPIN
NC1032FOtherBCBSNC
NCP00179733OtherRAILROAD MEDICARE