Healthcare Provider Details

I. General information

NPI: 1346507340
Provider Name (Legal Business Name): JOHN KELLY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR DEPARTMENT OF PEDIATRIC CARDIOLOGY
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

700 CHILDRENS DR DEPARTMENT OF PEDIATRIC CARDIOLOGY
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-3108
  • Fax:
Mailing address:
  • Phone: 614-722-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35-127016
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-127016
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: