Healthcare Provider Details

I. General information

NPI: 1982915955
Provider Name (Legal Business Name): KATHLEEN KILLILEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 SMYTH RD
MANCHESTER NH
03104-7007
US

IV. Provider business mailing address

718 SMYTH RD
MANCHESTER NH
03104-7007
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax: 603-314-4479
Mailing address:
  • Phone: 603-624-4366
  • Fax: 603-314-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number268976
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: