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NPI Code Detail

MEDICARE: RAYMOND KELLY MD

MEDICARE: RAYMOND 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
1207P00000XEmergency Medicine Physician310122NY
2207P00000XEmergency Medicine Physician4301115520MI

General Provider Information

NPI Number : 1295228633
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYMOND KELLY MD
Provider Business Mailing Address
First Line : 40 GATES CIR UPPR
Second Line :
City : BUFFALO
State : NY
Zip : 14209-1143
Country : US
Telephone Number : 585-880-8832
Fax Number :
Provider Business Practice Location Address
First Line : 2950 ELMWOOD AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14217-1304
Country : US
Telephone Number : 716-447-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2018
Last Update Date : 07/02/2021

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