Provider Demographics
NPI:1285627778
Name:KILLIAN, STEPHEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6480
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:3169 BRAVERTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2679
Practice Address - Country:US
Practice Address - Phone:410-956-4911
Practice Address - Fax:410-956-4935
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2108711OtherAETNA HMO
32789009OtherBCBS
MD3418811100Medicaid
5854249OtherAETNA PPO
145724700OtherFEDERAL WORKMANS COMP
813341OtherMAMSI
0001OtherBCBS
9958OtherKAISER
32789009OtherBCBS
C49080Medicare UPIN
MD3418811100Medicaid