Provider Demographics
NPI:1215004718
Name:KILLIAN, DERMOT NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DERMOT
Middle Name:NICHOLAS
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2112 SOUNDINGS CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3737
Mailing Address - Country:US
Mailing Address - Phone:757-953-2075
Mailing Address - Fax:757-953-0832
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-2075
Practice Address - Fax:757-953-0832
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME008344207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME008344OtherLICENSE