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General NPI Number Information
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NPI Number | 1982915955
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Entity Type | Individual
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Provider Name | KATHLEEN KILLILEA MD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 1400 VFW PARKWAY VA BOSTON HEALTHCARE
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City | WEST ROXBURY
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State | MA
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Zip | 02132
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Country | US
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Telephone | 857-203-5096
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Fax | 857-203-5777
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Provider Business Mailing Address
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Address Line | 1400 VFW PARKWAY VA BOSTON HEALTHCARE
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City | WEST ROXBURY
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State | MA
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Zip | 02132
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Country | US
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Telephone | 857-203-5096
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Fax | 857-203-5777
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 244618
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 268976
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 268976
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License Number State | MA
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