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General NPI Number Information
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NPI Number | 1801278783
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Entity Type | Individual
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Provider Name | MICHAEL KELLY
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Gender | Male
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 166 KINSLEY ST STE 201
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City | NASHUA
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State | NH
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Zip | 03060
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Country | US
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Telephone | 603-880-9177
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Fax | 603-880-9672
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Provider Business Mailing Address
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Address Line | C/O ST MARYS HEALTH SYSTEM PO BOX 7291
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City | LEWISTON
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State | ME
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Zip | 04243-7291
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Country | US
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Telephone | 207-777-8695
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Fax | 207-777-8800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | LL 1332
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0371
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License Number State | NH
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