MEDICARE: DR. JAMES REGINALD KELLY MD, MBA

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	207R00000X	Internal Medicine Physician	20735	NC

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	:	1922004191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES REGINALD KELLY MD, MBA

Provider Business Mailing Address
First Line	:	1301 FAYETTEVILLE ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2325
Country	:	US
Telephone Number	:	919-956-4508
Fax Number	:

Provider Business Practice Location Address
First Line	:	DUMC 3022
Second Line	:	WALLACE CLINIC
City	:	DURHAM
State	:	NC
Zip	:	27710-0001
Country	:	US
Telephone Number	:	919-660-6746
Fax Number	:	919-681-4849

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/11/2019

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