Basic Information
| Provider Information | |||||||||
| NPI: | 1629503586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KILPATRICK | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | BOX 286 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365078 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 WASHINGTON ST | ||||||||
| Address2: | BOX 286 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365078 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 271837 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.