MEDICARE: ANITA KELSEY MD

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	207RC0000X	Cardiovascular Disease Physician	034104	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083617161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA KELSEY MD

Provider Business Mailing Address
First Line	:	1000 ASYLUM AVE
Second Line	:	STE 2109A
City	:	HARTFORD
State	:	CT
Zip	:	06105-1719
Country	:	US
Telephone Number	:	860-714-6581
Fax Number	:	860-714-8311

Provider Business Practice Location Address
First Line	:	114 WOODLAND ST
Second Line	:	CARDIOLOGY
City	:	HARTFORD
State	:	CT
Zip	:	06105-1208
Country	:	US
Telephone Number	:	860-714-4821
Fax Number	:	860-714-8001

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/27/2013

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