Healthcare Provider Details

I. General information

NPI: 1508184441
Provider Name (Legal Business Name): MARIANN NOCERA KELLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANN NOCERA MD

II. Dates (important events)

Enumeration Date: 05/16/2010
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 203-233-4930
  • Fax:
Mailing address:
  • Phone: 203-233-4930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1.055475
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number1.055475
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD14413
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD14413
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: