Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | 043422 | CT |
Y | 207RX0202X | Medical Oncology | OS006196L | PA |
NPI | 1013905512 |
---|---|
Provider Name | William Kevin Kelly |
First Address | Philadelphia, PA 19107-4216 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 31/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001434224 | (05) | CT |
0232017 | (05) | NJ |
102474035 | (05) | PA |
F55080 | (02) |