Healthcare Provider Details

I. General information

NPI: 1548422561
Provider Name (Legal Business Name): BRIGID KELLEY KILLELEA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LOCK STREET
NEW HAVEN CT
06511
US

IV. Provider business mailing address

PO BOX 208237
NEW HAVEN CT
06520-8237
US

V. Phone/Fax

Practice location:
  • Phone: 203-432-0076
  • Fax: 203-432-7289
Mailing address:
  • Phone: 203-432-0076
  • Fax: 203-432-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number048168
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number048168
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: