Individual
DR. LEROY J KELLEY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
24 WALPOLE ST FL 1, NORWOOD, MA 02062-3356
(781) 762-4205
(781) 255-7905
Mailing address
24 WALPOLE ST FL 1, NORWOOD, MA 02062-3356
(781) 762-4205
(781) 255-7905
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1496
MA
213ES0131X
Foot Surgery Podiatrist
1496
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0335797
—
MA
01
—
042715679
TAX ID
MA
01
—
1496
STATE ID
MA
01
—
LXO122
PTAN
MA
01
—
V09521
UPIN
MA
01
—
Y70632
BC/BS
MA
Enumeration date
11/08/2005
Last updated
12/01/2020
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