Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | DO00604 | RI |
NPI | 1548200074 |
---|---|
Provider Name | Susan C Kelly |
First Address | North Kingstown, RI 02852-7135 |
Second Address | North Kingstown, RI 02852-7135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 07/07/2011 |