MEDICARE: KELLY FLYNN 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	207V00000X	Obstetrics & Gynecology Physician	036405	CT
2	207VG0400X	Gynecology Physician	229645	MA

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

General Provider Information

NPI Number	:	1831197896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY FLYNN MD

Provider Business Mailing Address
First Line	:	15 BRACKETT ST
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02492-1606
Country	:	US
Telephone Number	:	781-400-5296
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 DIMOCK ST
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-1029
Country	:	US
Telephone Number	:	617-442-8800
Fax Number	:	617-541-8334

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	03/15/2013

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Directions to “ KELLY FLYNN MD” Practice Location

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