Healthcare Provider Details

I. General information

NPI: 1407051014
Provider Name (Legal Business Name): AMY KELLEY CHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MORGAN KELLEY

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 HIGHGATE ST
NEEDHAM MA
02492-3936
US

IV. Provider business mailing address

98 HIGHGATE ST
NEEDHAM MA
02492-3936
US

V. Phone/Fax

Practice location:
  • Phone: 215-704-9829
  • Fax:
Mailing address:
  • Phone: 215-704-9829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number243272
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: