Provider Demographics
NPI:1053754218
Name:TROTT, KILEY EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:KILEY
Middle Name:EDWARD
Last Name:TROTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2715
Mailing Address - Country:US
Mailing Address - Phone:484-797-7985
Mailing Address - Fax:
Practice Address - Street 1:1 PARK STREET
Practice Address - Street 2:WING WEST PAVILION FL 2ND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06504
Practice Address - Country:US
Practice Address - Phone:203-785-5430
Practice Address - Fax:203-785-3970
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT62583207Y00000X, 207YP0228X
NJ25MA12125800207Y00000X, 207YP0228X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program