Healthcare Provider Details

I. General information

NPI: 1528231552
Provider Name (Legal Business Name): ANDREW KILLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MORGAN ST STE 108
STAMFORD CT
06905-5436
US

IV. Provider business mailing address

2660 MAIN ST 216
BRIDGEPORT CT
06606-5301
US

V. Phone/Fax

Practice location:
  • Phone: 203-359-9997
  • Fax:
Mailing address:
  • Phone: 203-576-5346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number046395
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: