MEDICARE: WILLIAM FRANCIS KELLY P.A.

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	363A00000X	Physician Assistant	C00389	MD

General Provider Information

NPI Number	:	1194766394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM FRANCIS KELLY P.A.

Provider Business Mailing Address
First Line	:	5100 BUCKEYSTOWN PIKE
Second Line	:	SUITE 186
City	:	FREDERICK
State	:	MD
Zip	:	21704-8336
Country	:	US
Telephone Number	:	301-682-8888
Fax Number	:	301-682-3515

Provider Business Practice Location Address
First Line	:	5100 BUCKEYSTOWN PIKE
Second Line	:	SUITE 186
City	:	FREDERICK
State	:	MD
Zip	:	21704-8336
Country	:	US
Telephone Number	:	301-682-8888
Fax Number	:	301-682-3515

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	09/06/2013

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