MEDICARE: MARYANN KELLY PA

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	363A00000X	Physician Assistant	PA1027531	PA

General Provider Information

NPI Number	:	1093881328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN KELLY PA

Provider Business Mailing Address
First Line	:	3300 ARAMINGO AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19134-4500
Country	:	US
Telephone Number	:	215-634-5110
Fax Number	:	215-634-5108

Provider Business Practice Location Address
First Line	:	3300 ARAMINGO AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19134-4500
Country	:	US
Telephone Number	:	215-634-5110
Fax Number	:	215-634-5108

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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Directions to “ MARYANN KELLY PA” Practice Location

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