Healthcare Provider Details

I. General information

NPI: 1023161965
Provider Name (Legal Business Name): KELBY MAHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

1030 PRESIDENT AVE
FALL RIVER MA
02720-5923
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-6833
  • Fax:
Mailing address:
  • Phone: 508-679-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number225898
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: