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General NPI Number Information
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NPI Number | 1114069549
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Entity Type | Organization
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Legal Business Name | ELEANOR KELLY, MD, INC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 1 HOAG DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4162
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Country | US
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Telephone | 949-735-0174
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Fax | 949-854-7143
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Provider Business Mailing Address
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Address Line | 5100 BIRCH ST 2ND FLOOR
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2160
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Country | US
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Telephone | 949-735-0174
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Fax | 949-854-7143
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ELEANOR MARIE KELLY
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Credential | MD
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Telephone | 949-735-0174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A064544
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License Number State | CA
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