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NPI Code Detail

MEDICARE: KELLEY J. STANLEY MD

MEDICARE: KELLEY J. STANLEY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD22289ME

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110069191OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013005313
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLEY J. STANLEY MD
Provider Business Mailing Address
First Line : 180 CHURCH HILL RD
Second Line :
City : LEEDS
State : ME
Zip : 04263-3418
Country : US
Telephone Number : 207-524-3501
Fax Number : 207-524-2093
Provider Business Practice Location Address
First Line : 11 ACADEMY RD
Second Line :
City : MONMOUTH
State : ME
Zip : 04259-7035
Country : US
Telephone Number : 207-524-3501
Fax Number : 207-933-9645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 06/25/2021

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