Provider Demographics
NPI:1902906860
Name:KITKO, TERESA M (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:KITKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 CHRISTIANA ROAD, SUITE 202
Mailing Address - Street 2:DELAWARE NEUROSURGICAL GROUP, PA
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-366-7671
Mailing Address - Fax:302-366-7549
Practice Address - Street 1:774 CHRISTIANA ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-366-7671
Practice Address - Fax:302-366-7549
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000127363AS0400X
MDC0001174363AS0400X
DEC5-0000127363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE520084M04Medicare PIN
DER29367Medicare UPIN
R29367Medicare UPIN
MD456P890GMedicare PIN