Provider Demographics
NPI:1750305330
Name:KILLION, BETTINA WEIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:BETTINA
Middle Name:WEIS
Last Name:KILLION
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 1:10 DAVOL SQ
Mailing Address - Street 2:STE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:850 AQUIDNECK AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7280
Practice Address - Country:US
Practice Address - Phone:401-846-0055
Practice Address - Fax:401-842-0963
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1750305330Medicaid
RIU400369108Medicare PIN
IL14D0991123OtherCLIA #
IL705600OtherMEDICARE GROUP #
IL036114236Medicaid
IL01630151OtherBCBS PROVIDER GROUP #