MEDICARE: KELSEY LAMELZA SP029047

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	SP029047	PA

General Provider Information

NPI Number	:	1073384210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY LAMELZA SP029047

Provider Business Mailing Address
First Line	:	6673 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2252
Country	:	US
Telephone Number	:	215-247-2996
Fax Number	:	215-247-7504

Provider Business Practice Location Address
First Line	:	6673 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2252
Country	:	US
Telephone Number	:	215-247-2996
Fax Number	:	215-247-7504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	01/16/2024

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