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General NPI Number Information
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NPI Number | 1598953739
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Entity Type | Organization
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Legal Business Name | RAYMOND J KELLY, M.D. INC
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 100 S ELLSWORTH AVE SUITE 301
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City | SAN MATEO
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State | CA
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Zip | 94401-3939
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Country | US
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Telephone | 650-344-2561
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Fax | 650-344-2563
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Provider Business Mailing Address
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Address Line | 100 S ELLSWORTH AVE SUITE 301
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City | SAN MATEO
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State | CA
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Zip | 94401-3939
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Country | US
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Telephone | 650-344-2561
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Fax | 650-344-2563
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. RAYMOND J KELLY
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Credential |
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Telephone | 650-344-2561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | G 023921
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License Number State | CA
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