Provider Demographics
NPI:1700215043
Name:KILBY PEDIATRICS, LLC
Entity Type:Organization
Organization Name:KILBY PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:KILBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-987-9508
Mailing Address - Street 1:191 SHARP ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SPERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22740-2346
Mailing Address - Country:US
Mailing Address - Phone:540-987-9508
Mailing Address - Fax:540-987-9508
Practice Address - Street 1:191 SHARP ROCK RD
Practice Address - Street 2:
Practice Address - City:SPERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22740-2346
Practice Address - Country:US
Practice Address - Phone:540-987-9508
Practice Address - Fax:540-987-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019886208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6715796Medicaid
VA0101019886OtherLICENSE