Provider Demographics
NPI:1609826353
Name:KILLGORE, CARA R (MD)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:R
Last Name:KILLGORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:R
Other - Last Name:TRAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:424 WARDS CORNER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6966
Mailing Address - Country:US
Mailing Address - Phone:513-576-7700
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:4627 AICHOLTZ RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1447
Practice Address - Country:US
Practice Address - Phone:513-753-2820
Practice Address - Fax:513-753-2824
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098402208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070922Medicaid