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General NPI Number Information
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NPI Number | 1740561778
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Entity Type | Organization
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Legal Business Name | SHORE COMMUNITY MEDICAL LLC
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Dates
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Enumeration Date | 09/04/2011
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 18947 JOHN J WILLIAMS HWY SUITE 306
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4474
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Country | US
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Telephone | 302-827-4365
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Fax | 302-827-4359
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Provider Business Mailing Address
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Address Line | 18947 JOHN J WILLIAMS HWY SUITE NUMBER 306
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4474
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Country | US
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Telephone | 302-827-4365
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Fax | 302-827-4359
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Authorized Official
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Title or Position | MEMBER
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Name | DR. THOMAS FRANCIS KELLY
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Credential | M.D.
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Telephone | 302-827-4365
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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 | C10006041
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License Number State | DE
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