Healthcare Provider Details

I. General information

NPI: 1417910977
Provider Name (Legal Business Name): DOROTHY H KELLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HOSPITAL DR D/B/A: WESTERN MASS PEDIATRICS
HOLYOKE MA
01040-6606
US

IV. Provider business mailing address

260 NEW LUDLOW ROAD
CHICOPEE MA
01020-4324
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-2800
  • Fax: 413-534-2801
Mailing address:
  • Phone: 413-533-3470
  • Fax: 413-533-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12937
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36427
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: