Healthcare Provider Details

I. General information

NPI: 1306818497
Provider Name (Legal Business Name): ALICIA ANN MCKELVEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 280 LANKENAU MED SCI BLDG.
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE SUITE 280 LANKENAU MED SCI BLDG.
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 484-527-0404
  • Fax: 610-527-0824
Mailing address:
  • Phone: 484-527-0404
  • Fax: 610-527-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number042616
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD425541
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number042616
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: