MEDICARE: DR. MAUREEN KELLY M.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	207VE0102X	Reproductive Endocrinology Physician	MD047210L	PA
2	207VG0400X	Gynecology Physician	MD047210L	PA

General Provider Information

NPI Number	:	1942367461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAUREEN KELLY M.D.

Provider Business Mailing Address
First Line	:	815 LOCUST ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5504
Country	:	US
Telephone Number	:	215-922-2066
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 LOCUST ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5504
Country	:	US
Telephone Number	:	215-922-2066
Fax Number	:

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	09/11/2025

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