Provider Demographics
NPI:1598028177
Name:KILGANNON, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KILGANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-2014
Mailing Address - Country:US
Mailing Address - Phone:914-490-8121
Mailing Address - Fax:
Practice Address - Street 1:62 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-2014
Practice Address - Country:US
Practice Address - Phone:914-490-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2024-05-08
Deactivation Date:2015-03-04
Deactivation Code:
Reactivation Date:2024-05-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist