Basic Information
| Provider Information | |||||||||
| NPI: | 1740201854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TILMAN | ||||||||
| FirstName: | KERI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 WHIPPLE ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029083258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018542504 | ||||||||
| FaxNumber: | 4014277795 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 FRIENDSHIP ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028402209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018451593 | ||||||||
| FaxNumber: | 4018470650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD12106 | RI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | U400167702 | 01 | RI | MEDICARE NGS | OTHER | 1740201854 | 01 | NPI | OTHER | 6743-2 | 01 | RI | BLUE CROSS | OTHER | 7058778 | 05 | RI | MEDICAID | 110100566A | 01 | RI | MASS MEDICAID | OTHER |