MEDICARE: DR. KELLEY SHULTZ 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	208000000X	Pediatrics Physician	35.055406	OH
2	208000000X	Pediatrics Physician	9556	NH

General Provider Information

NPI Number	:	1548262504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLEY SHULTZ MD

Provider Business Mailing Address
First Line	:	250 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-7539
Country	:	US
Telephone Number	:	603-228-7200
Fax Number	:	603-228-7307

Provider Business Practice Location Address
First Line	:	250 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-7539
Country	:	US
Telephone Number	:	603-228-7200
Fax Number	:	603-228-7307

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	05/11/2016

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