Provider Demographics
NPI:1114939170
Name:BAILL, KEVIN E (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:BAILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4800
Mailing Address - Country:US
Mailing Address - Phone:401-455-6663
Mailing Address - Fax:401-455-6592
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6663
Practice Address - Fax:401-455-6592
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME169362084P0800X
RIMD121792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE
RI32135-8OtherBLUE CROSS
RI007059177OtherMEDICARE ID-TYPE UNSPECIFIED
ME432058299Medicaid
RI4939170Medicaid
RI413937OtherBLUE CHIP
RI1104801349OtherBUTLER HOSPITAL NPI
RI413937OtherBLUE CHIP