MEDICARE: DR. STEPHEN E KILLIAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0029193	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2108711	OTHER	AETNA HMO
2	32789009	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5854249	OTHER	AETNA PPO
5	145724700	OTHER	FEDERAL WORKMANS COMP
6	813341	OTHER	MAMSI
7	0001	OTHER	BCBS
8	9958	OTHER	KAISER

General Provider Information

NPI Number	:	1285627778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN E KILLIAN MD

Provider Business Mailing Address
First Line	:	PO BOX 12622
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4017
Country	:	US
Telephone Number	:	443-481-6480
Fax Number	:	443-481-6515

Provider Business Practice Location Address
First Line	:	3169 BRAVERTON ST
Second Line	:	SUITE 201
City	:	EDGEWATER
State	:	MD
Zip	:	21037-2679
Country	:	US
Telephone Number	:	410-956-4911
Fax Number	:	410-956-4935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	04/01/2015

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Directions to “ DR. STEPHEN E KILLIAN MD” Practice Location

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