Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 049554 | CT |
N | 207T00000X | Neurosurgeon | 80789 | AZ |
NPI | 1043490097 |
---|---|
Provider Name | Dr. Brendan Dyer Killory |
First Address | Hartford, CT 06106-5501 |
Second Address | Hartford, CT 06106-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049554 | CONNECTICARE (01) | CT |
1043490097 | (05) | CT |
7432716 | CIGNA (01) | CT |
7432716 | GREAT WEST HEALTHCARE (01) | CT |
80789 | TRAINING PERMIT (01) | AZ |
P4362821 | OXFORD (01) | CT |