Healthcare Provider Details

I. General information

NPI: 1295469104
Provider Name (Legal Business Name): KELLY MCLAUGHLIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WALNUT ST
PHILADELPHIA PA
19107-5211
US

IV. Provider business mailing address

1941 LIMESTONE RD STE 101
WILMINGTON DE
19808-5413
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7000
  • Fax: 215-503-9170
Mailing address:
  • Phone: 302-655-9494
  • Fax: 302-691-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: