MR. TRENTON TYLER KELLOCK (NPI# 1154811800) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154811800 |
| Entity Type | Individual |
| Full Name | MR. TRENTON TYLER KELLOCK |
| Credential | MD |
| Practice Address |
75 Francis St. Msk Fellowship, Dept. of Radiology, Ra-3, Brigham & Wom Boston MA 02115 |
| Mailing Address |
Women's Hospital Department of Radiology 75 Francis St, Attn Dr Tenton Kellock Boston MA 02115 |
| Practice Telephone | 6177326266 |
| Practice Fax Number | 9783529015 |
| Mailing Telephone | 6177327537 |
| Mailing Fax Number | 6177326336 |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2019-01-15 |
| NPI Deactivation Date | 01/09/2019 |
| NPI Reactivation Date | 2019-01-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
75 FRANCIS ST. MSK FELLOWSHIP, DEPT. OF RADIOLOGY, RA-3, BRIGHAM & WOM |
| City | BOSTON |
| State | MA |
| Zip Code | 02115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861598179 | Richard J Benjamin | Pathology | 75 Francis St., Brigham & Women's Hosp, Boston, MA 02115 | 2006-09-15 |
| 1578030250 | Carla B Monteiro | Social Worker | 75 Francis St., Tower 1st Floor. Suite 159, Boston, MA 02115-6110 | 2018-10-31 |
| 1598260283 | Olivia Buck | Student in an Organized Health Care Education/Training Program | 75 Francis St., Asb1-3-608a, Dept. of Ob/gyn Residency, Boston, MA 02115 | 2018-03-26 |
| 1053832444 | John C Lamacchia | Pathology | 75 Francis St., Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115 | 2017-07-06 |
| 1003349234 | David Kolin | Pathology | 75 Francis St., Department of Pathology, Boston, MA 02115 | 2017-04-05 |
| 1588110134 | Jason Schenkel | Pathology | 75 Francis St., Boston, MA 02115 | 2016-09-01 |
| 1174907224 | Revathi Shekar | Oral Medicinist | 75 Francis St., Boston, MA 02115 | 2015-07-17 |
| 1184001216 | Eli T Sayegh | Orthopaedic Surgery | 75 Francis St., Boston, MA 02115 | 2015-04-27 |
| 1639464001 | Prescilia Nwabiani Isedeh | Internal Medicine | 75 Francis St., Boston, MA 02215 | 2011-06-14 |
| 1154626695 | Christine Mary Harker | Nurse Practitioner | 75 Francis St., Occupational Health Dept. Mid Campus Ground Pike, Boston, MA 02115 | 2011-01-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524339 | Jacqueline Busa | Student in an Organized Health Care Education/Training Program | Northeastern University 336 Huntington Ave, Boston, MA 02115 | 2020-09-30 |
| 1417564279 | Katherine Rose Brainard | Student in an Organized Health Care Education/Training Program | 336 Huntington Avenue, Boston, MA 02115 | 2020-09-25 |
| 1679189112 | Tara Baxter | Orthopaedic Surgery | Boston Children's Hospital - Sports Medicine Division, 319 Longwood Avenue, Boston, MA 02115 | 2020-09-21 |
| 1053923110 | Wendy Tu | Student in an Organized Health Care Education/Training Program | 75 Francis Street Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115 | 2020-08-20 |
| 1477177335 | Nicolas Wyvekens | Student in an Organized Health Care Education/Training Program | 75 Francis Street Department of Pathology, Brigham And, Boston, MA 02115 | 2020-06-05 |
| 1669095923 | Erin Crocker | Student in an Organized Health Care Education/Training Program | Northeastern University Physician Assistant Program, 360 Huntington Avenue, Boston, MA 02115 | 2020-05-21 |
| 1033732417 | Tyler Francis Hayes | Student in an Organized Health Care Education/Training Program | Gordon Hall, Suite 213, 25 Shattuck Street, Boston, MA 02115 | 2020-05-20 |
| 1982225090 | Emily Blake | Student in an Organized Health Care Education/Training Program | 202 Robinson Hall, 360 Huntington Avenue, Boston, MA 02115 | 2020-04-29 |
| 1891315495 | Stephanie Schoch | Student in an Organized Health Care Education/Training Program | 360 Huntington Ave., 202 Robinson Hall, Boston, MA 02115 | 2020-04-23 |
| 1427678093 | Meghan Miles | Student in an Organized Health Care Education/Training Program | 360 Huntington Avenue 202 Robinson Hall, Boston, MA 02115 | 2020-04-23 |
| Find all providers in zip 02115 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447636 | Sarah Wieman | Student in an Organized Health Care Education/Training Program | 16 Blossom St Fl 1, Boston, MA 02114-3104 | 2020-11-03 |
| 1932709938 | Brianna Mae Duval | Student in an Organized Health Care Education/Training Program | 58 Colborne Rd, Boston, MA 02135-4103 | 2020-10-28 |
| 1780281279 | Sarah Hamad Alsaggabi | Student in an Organized Health Care Education/Training Program | 55 Traveler St Apt 1310, Boston, MA 02118-2973 | 2020-10-07 |
| 1821695933 | Matthew John Needham | Student in an Organized Health Care Education/Training Program | 330 Brookline Ave, Yamins 2nd Floor, Department of Anesthesia, Boston, MA 02215 | 2020-10-02 |
| 1013524339 | Jacqueline Busa | Student in an Organized Health Care Education/Training Program | Northeastern University 336 Huntington Ave, Boston, MA 02115 | 2020-09-30 |
| 1558978957 | Tien-hsin Chang | Student in an Organized Health Care Education/Training Program | 1 Kneeland Street (tufts University School of Dental Me, Boston, MA 02111 | 2020-09-29 |
| 1417564279 | Katherine Rose Brainard | Student in an Organized Health Care Education/Training Program | 336 Huntington Avenue, Boston, MA 02115 | 2020-09-25 |
| 1962018069 | Cara Connors | Student in an Organized Health Care Education/Training Program | 18 Wiget St Apt 1, Boston, MA 02113-2363 | 2020-09-23 |
| 1023624608 | Bernadette Avila | Student in an Organized Health Care Education/Training Program | 19 Peterborough St Apt 5, Boston, MA 02215-4409 | 2020-09-19 |
| 1588276281 | Guoliang Qiao | Student in an Organized Health Care Education/Training Program | Massachusetts General Hospital, 55 Fruit Street., Boston, MA 02114 | 2020-08-24 |
| Find all providers in BOSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.