Provider Demographics
NPI:1184678252
Name:KILBOURN, CYNTHIA (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KILBOURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:694 GOOD DR
Practice Address - Street 2:SUITE 11
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2433
Practice Address - Country:US
Practice Address - Phone:717-544-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054151L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP002757OtherGATEWAY
PA000000127020OtherUNISON
PA769974OtherHEALTHAMERICA
PA20038877OtherAMERIHEALTH MERCY
PA0739811000OtherINDEPENDENCE BLUE CROSS
PA1417873OtherAETNA
PA50056057OtherCAPITAL BLUE CROSS
PA000545644OtherHIGHMARK BLUE SHIELD
PA001492054 0008Medicaid
PA001492054 0008Medicaid