Healthcare Provider Details

I. General information

NPI: 1003466160
Provider Name (Legal Business Name): GENEVIEVE CECILE KELA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 INDIAN RIVER RD STE 300
ORANGE CT
06477-3695
US

IV. Provider business mailing address

250 INDIAN RIVER RD STE 300
ORANGE CT
06477-3695
US

V. Phone/Fax

Practice location:
  • Phone: 203-713-5600
  • Fax:
Mailing address:
  • Phone: 203-713-5600
  • Fax: 203-713-5656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73830
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number73830
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: