Provider Demographics
NPI:1376617167
Name:KILRAIN, MAUREEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:KILRAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 GRAFTON RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2307
Mailing Address - Country:US
Mailing Address - Phone:440-476-8428
Mailing Address - Fax:
Practice Address - Street 1:3059 GRAFTON RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:440-476-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000720RX363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50000720OtherOHIO STATE MEDICAL LICENSE
OHXK3897583OtherDEA X-WAIVER REGISTRATION NUMBER
OH1025633OtherNCCPA CERTIFICATE NUMBER
OHMK3897583OtherDEA REGISTRATION NUMBER