Provider Demographics
NPI:1538275987
Name:ZELLER, KATHLEEN RAE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:RAE
Last Name:ZELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:2444 EAST MAIN ROAD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4025
Practice Address - Country:US
Practice Address - Phone:401-683-4817
Practice Address - Fax:508-973-0318
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD13919207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKZ91826Medicaid
RIKZ91826Medicaid
TX83X025Medicare PIN
TX110107613OtherRR MEDICARE