Healthcare Provider Details

I. General information

NPI: 1316960198
Provider Name (Legal Business Name): DONNA MARIE KILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FLYNN AVE
BURLINGTON VT
05401
US

IV. Provider business mailing address

208 FLYNN AVE 3J
BURLINGTON VT
05401-5420
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-6405
  • Fax: 802-488-6201
Mailing address:
  • Phone: 802-488-6934
  • Fax: 802-488-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042-0009865
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: