Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 135828 | NY |
NPI | 1205080850 |
---|---|
Provider Name | Dr. Peter Hamilton Kelly |
First Address | Latham, NY 12110 |
Second Address | Latham, NY 12110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2008 |
Last Update Date | 10/11/2008 |