MEDICARE: KEVIN M KELLY 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	2084N0400X	Neurology Physician	MD057072L	PA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356342109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN M KELLY MD

Provider Business Mailing Address
First Line	:	420 E NORTH AVE STE 206
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-4746
Country	:	US
Telephone Number	:	412-359-8850
Fax Number	:	412-359-8878

Provider Business Practice Location Address
First Line	:	420 E NORTH AVE STE 206
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-4746
Country	:	US
Telephone Number	:	412-359-8850
Fax Number	:	412-359-8878

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/30/2020

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Directions to “ KEVIN M KELLY MD” Practice Location

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