Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | OS017850 | PA |
NPI | 1003229162 |
---|---|
Provider Name | Kelly Hay |
First Address | Bethlehem, PA 18018-5718 |
Second Address | Bethlehem, PA 18015-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 18/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103075625 | (05) | PA |
462706 | MEDICARE (01) | PA |