MEDICARE: THOMAS GERALD KELLY M.D.

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
1	2080P0205X	Pediatric Endocrinology Physician	A88790	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1134236623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS GERALD KELLY M.D.

Provider Business Mailing Address
First Line	:	550 WASHINGTON ST
Second Line	:	STE #300
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2213
Country	:	US
Telephone Number	:	619-297-5437
Fax Number	:	619-297-4567

Provider Business Practice Location Address
First Line	:	550 WASHINGTON ST
Second Line	:	STE #300
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2213
Country	:	US
Telephone Number	:	619-297-5437
Fax Number	:	619-297-4567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	12/02/2021

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