Provider Demographics
NPI:1164050308
Name:KILBURN, ANGIE E (NP ADULT HEALTH)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:E
Last Name:KILBURN
Suffix:
Gender:F
Credentials:NP ADULT HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 JAMES RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:12865-5030
Mailing Address - Country:US
Mailing Address - Phone:518-414-8322
Mailing Address - Fax:
Practice Address - Street 1:375 BAY RD STE 1
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3012
Practice Address - Country:US
Practice Address - Phone:518-932-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310837-01207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty