Individual
DR. BLAZE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
(203) 384-3000
(203) 384-4108
Mailing address
111 S 11TH ST STE 8290, PHILADELPHIA, PA 19107-4824
(215) 955-2370
(215) 955-0677
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
81122
CT
390200000X
Student in an Organized Health Care Education/Training Program
OT019937
PA
Other
Enumeration date
04/03/2020
Last updated
05/16/2025
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