Individual
DR. IAN A KELLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
625 HAMPTON RD, SHAVERTON, PA 18708-9526
(570) 881-3354
(570) 696-0174
Mailing address
625 HAMPTON RD, SHAVERTON, PA 18708-9526
(570) 881-3354
(570) 696-0174
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
MD017470E
PA
2085R0202X
Diagnostic Radiology Physician
Primary
MD017470E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006544430001
—
PA
Enumeration date
01/26/2006
Last updated
06/13/2024
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