Basic Information
| Provider Information | |||||||||
| NPI: | 1306263843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLINGTON | ||||||||
| FirstName: | KATE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 ELLENFIELD ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029054541 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 PLAIN STREET 3RD FLOOR | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029025724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014445504 | ||||||||
| FaxNumber: | 4017938101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2014 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 269726 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0205X | MD18450 | RI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 110118015A | 05 | MA | MEDICAID |