Healthcare Provider Details

I. General information

NPI: 1669669727
Provider Name (Legal Business Name): KELLY MARTINEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY BIAFORE

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST DEPARTMENT OF SURGERY
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

114 WOODLAND ST DEPARTMENT OF SURGERY
HARTFORD CT
06105-1208
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4694
  • Fax: 860-714-8096
Mailing address:
  • Phone: 860-714-4694
  • Fax: 860-714-8096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: