Provider Demographics
NPI:1346216033
Name:KILROY, TERENCE (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:KILROY
Suffix:
Gender:M
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:PO BOX 771103
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-0047
Mailing Address - Country:US
Mailing Address - Phone:216-472-2730
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:14601 DETROIT AVE
Practice Address - Street 2:SUITE 650
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-228-1700
Practice Address - Fax:216-228-6275
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046110K207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0589117Medicaid
10826749OtherCAQH
OH0589117Medicaid
OHKI0567709Medicare PIN