Provider Demographics
NPI:1699706598
Name:BRILL, KRISTIN L (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:BRILL
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1100 WALNUT STREET
Mailing Address - Street 2:MOB 5TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5563
Mailing Address - Country:US
Mailing Address - Phone:215-955-6750
Mailing Address - Fax:215-923-8222
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 411
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2270
Practice Address - Fax:856-365-1180
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD073364L2086X0206X
NJ25MA07237800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA07237800OtherNJ STATE LICENSE