1346575289 NPI number — MR. JEFFREY C KILROY NP

Table of content: MR. JEFFREY C KILROY NP (NPI 1346575289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346575289 NPI number — MR. JEFFREY C KILROY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILROY
Provider First Name:
JEFFREY
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346575289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 HIGHLAND AVE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
NEWBURYPORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01950-3872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-463-7770
Provider Business Mailing Address Fax Number:
978-462-0220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
NEWBURYPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01950-3872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-463-7770
Provider Business Practice Location Address Fax Number:
978-462-0220
Provider Enumeration Date:
10/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN275429 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110072703A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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