Individual
CECYLIA KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3998 RED LION RD, EMERGENCY DEPARTMENT, PHILADELPHIA, PA 19114-1436
(215) 612-4963
(215) 612-4532
Mailing address
PO BOX 8500-6335, PHILADELPHIA, PA 19178-0001
(215) 807-8000
(215) 807-8235
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS013861
PA
207R00000X
Internal Medicine Physician
OS013861
PA
208M00000X
Hospitalist Physician
OS013861
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019454200001
—
PA
05
—
1019454200002
—
PA
05
—
1019454200003
—
PA
01
—
1973459
HIGHMARK BLUE SHIELD
PA
01
—
2852806000
PERSONAL CHOICE
PA
01
—
30043312
KEYSTONE MERCY
PA
01
—
38325
HEALTH PARTNERS
PA
Enumeration date
06/18/2007
Last updated
05/19/2008
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