Provider Demographics
NPI:1235107517
Name:KILEY, CATHERINE A (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:KILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3778 BROADVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-287-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH125608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB76013Medicare UPIN
RI29713-6OtherBCBSRI
MA6197981Medicaid
MA000000030318OtherBMCHEALTHNET
RI409720OtherBCBSRIBLUECHIP
MAAA36453OtherHARVARD PILGRIM
MAJ04762OtherBCBSMA
MA4238041OtherAETNA
MAA59383Medicare UPIN
MAJ04762Medicare ID - Type Unspecified
MA0535201OtherTUFTS
MA3630202-009OtherCIGNA PAL
MA3630202OtherCIGNA