Kelly, Michael R
Kelly, Michael R is an individual health care provider with primary practice located at 208 Mill Rd , Fairhaven MA 02719-5208. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Kelly, Michael R can be contacted via phone (508) 758-3781.Contact Information
Primary practice address
208 Mill Rd
Fairhaven MA 02719-5208
Phone: (508) 758-3781
Fax: (508) 758-4455
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 243308 | Massachusetts |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 243308 | Massachusetts |
Profile Details
| NPI number | 1679780761 |
|---|---|
| LBN Legal business name | Kelly, Michael R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 17th, 2007 |
| Last updated | Apr 22nd, 2020 - about 4 years ago |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679780761 | NPPES |
| Massachusetts | MEDICAID | 110086557A |
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