Provider Demographics
NPI:1952380123
Name:TILTON, DONALD CLARKE (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CLARKE
Last Name:TILTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3568
Mailing Address - Country:US
Mailing Address - Phone:302-674-4401
Mailing Address - Fax:
Practice Address - Street 1:793 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3568
Practice Address - Country:US
Practice Address - Phone:302-674-4401
Practice Address - Fax:302-674-4129
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-00006962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE160403Medicaid
DEB66502Medicare UPIN
DE160403Medicaid
DE015188B12Medicare Oscar/Certification
DE015346B45Medicare ID - Type UnspecifiedMILFORD MEMORIAL HOSPTIAL