Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD417641 | PA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD417641 | PA |
NPI | 1093793531 |
---|---|
Provider Name | Dr. Matthew James Kelly |
First Address | Camp Hill, PA 17011-4407 |
Second Address | Camp Hill, PA 17011-4407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 29/11/2021 |