Provider Demographics
NPI:1306890207
Name:KITTRELL, WILLIAM L JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:KITTRELL
Suffix:JR
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 1:1906 THOMSON DR
Mailing Address - Street 2:CENTRAL VIRGINIA SURGERY
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1009
Mailing Address - Country:US
Mailing Address - Phone:434-947-3933
Mailing Address - Fax:434-947-3988
Practice Address - Street 1:1906 THOMSON DR
Practice Address - Street 2:CENTRAL VIRGINIA SURGERY
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1009
Practice Address - Country:US
Practice Address - Phone:434-947-3933
Practice Address - Fax:434-947-3988
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222063208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020052086OtherMEDICARE RAILROAD
VA007300000Medicaid
G88429Medicare UPIN
020001500Medicare ID - Type Unspecified