Provider Demographics
NPI:1306621347
Name:KIL, EDA
Entity type:Individual
Prefix:MRS
First Name:EDA
Middle Name:
Last Name:KIL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:EDA
Other - Middle Name:
Other - Last Name:KIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:445 ARTISAN WAY APT 488
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1253
Mailing Address - Country:US
Mailing Address - Phone:781-408-7971
Mailing Address - Fax:
Practice Address - Street 1:37 WATER ST STE 1
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3044
Practice Address - Country:US
Practice Address - Phone:781-851-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health