Kelly, Martin J.

Kelly, Martin J. is an individual health care provider with primary practice located at 263 Farmington Ave Provider Enrollment, Farmington CT 06030-2212. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Kelly, Martin J. can be contacted via phone (860) 679-7503.

Contact Information

Primary practice address
263 Farmington Ave Provider Enrollment Farmington CT 06030-2212
Phone: (860) 679-7503
Fax: (860) 679-1610
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 000979 Connecticut

Profile Details

NPI number 1447300702
LBN Legal business name Kelly, Martin J.
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2007
Last updated Mar 7th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447300702 NPPES
Connecticut MEDICAID 003009792
Connecticut Other 30656
Connecticut Other 000979

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