Healthcare Provider Details

I. General information

NPI: 1225476914
Provider Name (Legal Business Name): KEVIN C. JILLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LUMBER ST STE 200
HOPKINTON MA
01748
US

IV. Provider business mailing address

9 INDUSTRIAL RD STE 5
MILFORD MA
01757-3736
US

V. Phone/Fax

Practice location:
  • Phone: 508-435-5936
  • Fax: 508-435-4616
Mailing address:
  • Phone: 508-473-1480
  • Fax: 508-473-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number275375
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number275375
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number255941
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number275375
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: