Healthcare Provider Details

I. General information

NPI: 1053754218
Provider Name (Legal Business Name): KILEY EDWARD TROTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK STREET WING WEST PAVILION FL 2ND FLOOR
NEW HAVEN CT
06504
US

IV. Provider business mailing address

34 ALDEN AVE
NEW HAVEN CT
06515-2715
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-5430
  • Fax: 203-785-3970
Mailing address:
  • Phone: 484-797-7985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number62583
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA12125800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number25MA12125800
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number62583
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: