Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD029316E | PA |
NPI | 1003982448 |
---|---|
Provider Name | Barbara Ann Kelly |
First Address | Philadelphia, PA 19120-2421 |
Second Address | Philadelphia, PA 19141-3018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E87939 | (02) | PA |