=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528387198
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLEY D. BABCOCK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2010
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 439 E 1ST ST
-----------------------------------------------------
City | BLOOMSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17815-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-387-1444
-----------------------------------------------------
Fax | 570-387-1961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 N ACADEMY AVE
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17822-4903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-387-1444
-----------------------------------------------------
Fax | 570-387-1961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MD491383C
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------