Provider Demographics
NPI:1063519064
Name:KILGORE, TERESA MARY (DO)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARY
Last Name:KILGORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:JOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6300
Mailing Address - Country:US
Mailing Address - Phone:864-454-0888
Mailing Address - Fax:864-454-1130
Practice Address - Street 1:2601 LAUREL ST STE 120
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2034
Practice Address - Country:US
Practice Address - Phone:803-227-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863OtherAETNA
SC002794Medicaid
SC57-6007863OtherBCBS
SC57-6007863OtherBLUE CHOICE
SC110234017OtherMEDICARE RAILROAD
SC57-6007863OtherTRICARE
SC110234017OtherMEDICARE RAILROAD
SC57-6007863OtherTRICARE