Provider Demographics
NPI:1831196542
Name:KILLMER, SCOTT M (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:KILLMER
Suffix:
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 1:102 BROOKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6761
Mailing Address - Country:US
Mailing Address - Phone:304-256-0770
Mailing Address - Fax:304-256-0772
Practice Address - Street 1:102 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6761
Practice Address - Country:US
Practice Address - Phone:304-256-0770
Practice Address - Fax:304-256-0772
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17037208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0126467000Medicaid
WV0126467000Medicaid
WVG22919Medicare UPIN