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1649271883

NPI Code Detail

MEDICARE: PETER J KELLY MD

MEDICARE: PETER J 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	207W00000X	Ophthalmology Physician	41270	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042744585	OTHER		COSTCARE PPO
2	042744585	OTHER		GEHA PPO
3	042744585	OTHER		CHOICECARE
4	350270	OTHER		CMHC
5	S030683	OTHER		CHAMPUS
6	042744585	OTHER		HMC PPO
7	0598171-003	OTHER		CIGNA
8	0000000020721	OTHER		HEALTHNET
9	0025915	OTHER		AETNA
10	042744585	OTHER		HCVM
11	1582315	OTHER		FIRST HEALTH
12	H15034	OTHER		BCBS
13	150714	OTHER		HARVARD PILGRIM
14	744585	OTHER		CONNECTICARE
15	MA1270	OTHER		EYEMED
16	042744585	OTHER		TAX ID
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	PAL: 39699	OTHER		DAVIS VISION

General Provider Information

NPI Number	:	1649271883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J KELLY MD

Provider Business Mailing Address
First Line	:	1504 N MAIN ST
Second Line	:
City	:	PALMER
State	:	MA
Zip	:	01069-1215
Country	:	US
Telephone Number	:	413-283-3511
Fax Number	:	413-283-5396

Provider Business Practice Location Address
First Line	:	1504 N MAIN ST
Second Line	:
City	:	PALMER
State	:	MA
Zip	:	01069-1215
Country	:	US
Telephone Number	:	413-283-3511
Fax Number	:	413-283-5396

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	06/17/2019

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Directions to “ PETER J KELLY MD” Practice Location

Language	Start Address	Practice Location

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