# DR. TIMOTHY J KELLY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1689731085
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | 30274 | SC | Yes |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 04/26/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1506232 | COVENTRY | — |
| 05 | — | 302746 | — | SC |
| 01 | — | AA21828218 | MEDICARE | SC |
| 01 | — | P01505878 | RAILROAD MEDICARE | SC |