Provider Demographics
NPI:1225067325
Name:DEBENHAM, KYLE WINDSOR (MD)
Entity Type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:WINDSOR
Last Name:DEBENHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KYLE
Other - Middle Name:WINDSOR
Other - Last Name:TILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:180 MAPLE AVE W
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5727
Practice Address - Country:US
Practice Address - Phone:703-938-5300
Practice Address - Fax:703-242-0726
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5578A207P00000X
MT41491207P00000X
VA0101266146207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106133017Medicaid
307739Medicare ID - Type Unspecified
WY106133017Medicaid