Provider Demographics
NPI:1689872764
Name:KELLIHER, KRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:KELLIHER
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 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-246-2071
Mailing Address - Fax:860-677-5029
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 415
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-246-2071
Practice Address - Fax:860-677-5029
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT48521208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061406459OtherCORVEL
CT061406459OtherTRICARE
CT061406459OtherWELLCARE
CT061406459OtherHEALTH NEW ENGLAND
CT1689872764OtherANTHEM BCBS
CT061406459OtherCOMMUNITY HEALTH NETWORK
CT061406459OtherPRIVATE HEALTHCARE SYSTEMS
CT061406459OtherUNITED HEALTHCARE
CT061406459OtherMULTIPLAN