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Individual
DR. MARY ALICE KELLY
Active
Individual
DR. MARY ALICE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1568631
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010089201
UNIVERA
—
01
—
000500738001
BCBS
—
01
—
0401537
IHA
—
Enumeration date
05/11/2006
Last updated
10/19/2012
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