Provider Demographics
NPI:1356317267
Name:CHILSON, TERRANCE SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:SCOTT
Last Name:CHILSON
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 1:1 KIM AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-9103
Mailing Address - Country:US
Mailing Address - Phone:570-836-4400
Mailing Address - Fax:570-836-4440
Practice Address - Street 1:1 KIM AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-9103
Practice Address - Country:US
Practice Address - Phone:570-836-4400
Practice Address - Fax:570-836-4440
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019128740005Medicaid
PA0019128740005Medicaid
PA060343ULVMedicare ID - Type Unspecified