MEDICARE: DAVID KELLY 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
1	174400000X	Specialist	224721	MA

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	:	1184618910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KELLY MD

Provider Business Mailing Address
First Line	:	PO BOX 1260
Second Line	:	ATT: DENISE COSTA
City	:	PLYMOUTH
State	:	MA
Zip	:	02362-1260
Country	:	US
Telephone Number	:	774-454-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 SANDWICH ST
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2183
Country	:	US
Telephone Number	:	508-830-2121
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	09/22/2010

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Directions to “ DAVID KELLY MD” Practice Location

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