Provider Demographics
NPI:1487766267
Name:HILTY, KENNETH CHANDLER (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHANDLER
Last Name:HILTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 NORTHLINE AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7616
Mailing Address - Country:US
Mailing Address - Phone:336-279-7900
Mailing Address - Fax:336-275-0433
Practice Address - Street 1:3200 NORTHLINE AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7616
Practice Address - Country:US
Practice Address - Phone:336-279-7900
Practice Address - Fax:336-275-0433
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2011-00375207RC0000X
SC30609207RC0000X
NY292417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine