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NPI Code Detail

MEDICARE: DR. MARK E. KILMER PHD

MEDICARE: DR. MARK E. KILMER PHD
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
1103T00000XPsychologist2806CO
2103TC0700XClinical PsychologistPS02231RI

General Provider Information

NPI Number : 1588688600
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK E. KILMER PHD
Provider Business Mailing Address
First Line : 513 BROADWAY
Second Line :
City : NEWPORT
State : RI
Zip : 02840-1471
Country : US
Telephone Number : 303-995-1188
Fax Number :
Provider Business Practice Location Address
First Line : 513 BROADWAY
Second Line :
City : NEWPORT
State : RI
Zip : 02840-1471
Country : US
Telephone Number : 303-995-1188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 08/19/2025

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