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Individual
DR. TIMOTHY J KELLY
Active
Individual
DR. TIMOTHY J KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
30274
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1506232
COVENTRY
—
05
—
302746
—
SC
01
—
AA21828218
MEDICARE
SC
01
—
P01505878
RAILROAD MEDICARE
SC
Enumeration date
01/03/2007
Last updated
04/26/2021
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