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General NPI Number Information
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NPI Number | 1407514193
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Entity Type | Organization
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Legal Business Name | PETER KELLY LLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 407 S 10TH ST STE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1274
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Country | US
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Telephone | 267-223-0205
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Fax | 678-487-5313
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Provider Business Mailing Address
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Address Line | 407 S 10TH ST STE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1274
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Country | US
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Telephone | 215-585-2342
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Fax | 267-376-4874
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Authorized Official
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Title or Position | OWNER
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Name | PETER KELLY
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Credential | DO
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Telephone | 267-223-0205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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