Provider Demographics
NPI:1457339392
Name:SPILLANE, KATHLEEN SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:SPILLANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:SUSAN
Other - Last Name:KIEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1776 WOODSTEAD CT STE 208
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1480
Mailing Address - Country:US
Mailing Address - Phone:877-749-7428
Mailing Address - Fax:512-628-3314
Practice Address - Street 1:1208 LANGHORNE NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:877-749-7428
Practice Address - Fax:512-628-3314
Is Sole Proprietor?:No
Enumeration Date:2005-12-31
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424219208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1647740OtherBLUE CHOICE / PERS CHOICE
PA7057597OtherAETNA PPO
PA4592562OtherCIGNA
PA101085702 0002Medicaid
PA4592562OtherCIGNA
PA3677241OtherAETNA HMO
PA4592562OtherCIGNA
G84399Medicare UPIN