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1770926131

NPI Code Detail

MEDICARE: KATHERINE KELLEY

MEDICARE: KATHERINE KELLEY

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	2086S0102X	Surgical Critical Care Physician	036152534	IL
2	208600000X	Surgery Physician	036152534	IL
3	208600000X	Surgery Physician	MC-048	GU
4	208600000X	Surgery Physician	1149	WI
5	2086S0127X	Trauma Surgery Physician	036152534	IL
6	2086S0102X	Surgical Critical Care Physician	MC-048	GU
7	2086S0102X	Surgical Critical Care Physician	D0086537	MD
8	2086S0127X	Trauma Surgery Physician	MD471120	PA

General Provider Information

NPI Number	:	1770926131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE KELLEY

Provider Business Mailing Address
First Line	:	3509 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5103
Country	:	US
Telephone Number	:	215-707-3133
Fax Number	:

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

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	02/03/2026

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Directions to “ KATHERINE KELLEY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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