Provider Demographics
NPI:1740201854
Name:TILMAN, KERI (MD)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:TILMAN
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 1:125 WHIPPLE ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3258
Mailing Address - Country:US
Mailing Address - Phone:401-854-2504
Mailing Address - Fax:401-427-7795
Practice Address - Street 1:11 FRIENDSHIP ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2209
Practice Address - Country:US
Practice Address - Phone:401-845-1593
Practice Address - Fax:401-847-0650
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12106207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU400167702OtherMEDICARE NGS
1740201854OtherNPI
RI6743-2OtherBLUE CROSS
RI7058778Medicaid
RI110100566AOtherMASS MEDICAID
1740201854OtherNPI
RI007058778Medicare PIN