Provider Demographics
NPI:1922132620
Name:LARRY S KILBY MD PA
Entity Type:Organization
Organization Name:LARRY S KILBY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KILBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-667-2668
Mailing Address - Street 1:1208 E ST
Mailing Address - Street 2:
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4018
Mailing Address - Country:US
Mailing Address - Phone:336-667-2668
Mailing Address - Fax:336-667-2668
Practice Address - Street 1:1208 E ST
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4018
Practice Address - Country:US
Practice Address - Phone:336-667-2668
Practice Address - Fax:336-667-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15953207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C80592Medicare UPIN