Provider Demographics
NPI:1669490801
Name:KILP, JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:KILP
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 1:603 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1227
Mailing Address - Country:US
Mailing Address - Phone:781-245-6334
Mailing Address - Fax:781-245-6332
Practice Address - Street 1:603 SALEM ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1227
Practice Address - Country:US
Practice Address - Phone:781-245-6334
Practice Address - Fax:781-245-6332
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50673207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6164676Medicaid
MAJ02124Medicare ID - Type Unspecified
MAA56378Medicare UPIN