Individual
SUSAN E KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
110 FRANCIS ST, SUITE 8E, BOSTON, MA 02215-5501
(617) 632-8623
Mailing address
110 FRANCIS STREET, SUITE 8E, BOSTON, MA 02215
(617) 632-8623
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
45873
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0142859
—
MA
01
—
30279
HARVARD PILGRIM
MA
Enumeration date
06/23/2006
Last updated
04/22/2011
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