Provider Demographics
NPI:1437178282
Name:TILGHMAN, KENNETH G (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:G
Last Name:TILGHMAN
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 1:4107 TWEEDSMUIR RD
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1290
Mailing Address - Country:US
Mailing Address - Phone:804-639-5106
Mailing Address - Fax:
Practice Address - Street 1:10442 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4408
Practice Address - Country:US
Practice Address - Phone:804-560-9240
Practice Address - Fax:804-560-9242
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054150208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA061663496OtherTRICARE
VA462448OtherANTHEM
VA6738125Medicaid
VA129450OtherAETNA
VA13733OtherSENTARA OPTIMA
VA8100327OtherMAMSI UNITEDHEALTHCARE
VA202874OtherSOUTHERN HEALTH
VA40340OtherCARENET