Healthcare Provider Details

I. General information

NPI: 1699015610
Provider Name (Legal Business Name): EDWARD GEORGE KELLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 9TH ST
PITTSBURGH PA
15222-3517
US

IV. Provider business mailing address

212 9TH ST
PITTSBURGH PA
15222-3517
US

V. Phone/Fax

Practice location:
  • Phone: 412-456-6689
  • Fax: 412-456-1883
Mailing address:
  • Phone: 412-456-6689
  • Fax: 412-456-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number002064
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: