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General NPI Number Information
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NPI Number | 1285627778
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Entity Type | Individual
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Provider Name | STEPHEN E KILLIAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 3169 BRAVERTON ST SUITE 201
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City | EDGEWATER
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State | MD
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Zip | 21037-2679
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Country | US
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Telephone | 410-956-4911
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Fax | 410-956-4935
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Provider Business Mailing Address
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Address Line | PO BOX 12622
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City | BELFAST
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State | ME
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Zip | 04915-4017
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Country | US
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Telephone | 443-481-6480
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Fax | 443-481-6515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0029193
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License Number State | MD
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