MEDICARE: DR. PATRICIA T KELLY PH.D.

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	170100000X	Ph.D. Medical Genetics

General Provider Information

NPI Number	:	1639159551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA T KELLY PH.D.

Provider Business Mailing Address
First Line	:	824 CRAGMONT AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94708-1304
Country	:	US
Telephone Number	:	510-527-8938
Fax Number	:

Provider Business Practice Location Address
First Line	:	824 CRAGMONT AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94708-1304
Country	:	US
Telephone Number	:	510-527-8938
Fax Number	:

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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