Kathleen Marie Petillo, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

263552 Issued in NY

Practice address

31 Roche Bros Way
North Easton, MA 02356

Phone

(508) 894-8760

Fax

(508) 894-8762

NPI assigned

May 1, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpetillo34580@direct.chppoc.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Hospital Pediatric Associates, Inc

  • Pediatrics Physician
  • Boston, MA
  • NPI 1457306664
  Medicare reassignment NPD
• Brockton Hospital, Inc.

  • Community/Retail Pharmacy
  • East Bridgewater, MA
  • NPI 1033084462
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1093949232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 ROCHE BROS WAY",
            "city": "NORTH EASTON",
            "state": "MA",
            "postal_code": "023561032",
            "telephone_number": "508-894-8760",
            "fax_number": "508-894-8762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 ROCHE BROS WAY",
            "city": "NORTH EASTON",
            "state": "MA",
            "postal_code": "02356",
            "telephone_number": "508-894-8760",
            "fax_number": "508-894-8762"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Maple Rd",
            "address_purpose": "LOCATION",
            "city": "Williamsville",
            "state": "NY",
            "postal_code": "142212749",
            "country_code": "US",
            "telephone_number": "716-636-5437",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "430 Liberty St",
            "address_purpose": "LOCATION",
            "city": "Hanson",
            "state": "MA",
            "postal_code": "023411113",
            "country_code": "US",
            "telephone_number": "781-293-3838",
            "fax_number": "781-293-3639",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 Maple Rd",
            "address_purpose": "LOCATION",
            "city": "Williamsville",
            "state": "NY",
            "postal_code": "142212749",
            "country_code": "US",
            "telephone_number": "716-636-5437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETILLO",
        "first_name": "KATHLEEN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-01",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "253293",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "263552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amelia Rose Louise Pepe, MS OTR/L
• Emily Pepyne, DPM, MPH
• Arianna Perez
• Lori Ann Maria Perretta, PSY.D.
• Jessica Perry, PSY.D.
• Jill N Petruchik, CCC-SLP
• Cindy Pham
• Lothida Phothisane
• Susan K Plante, APRN
• Jose Roman Polanco, MD

• Pediatrics Physician in North Easton, MA
• Providers in North Easton, MA by specialty
• Pediatrics Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.