Individual
DR. MARY M. KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
19020 33RD AVE W, SUITE 210, LYNNWOOD, WA 98036-4746
(425) 563-1500
(425) 563-1374
Mailing address
19020 33RD AVE W, SUITE 210, LYNNWOOD, WA 98036-4746
(425) 563-1500
(425) 563-1374
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD00019233
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1042266
—
WA
01
—
117364
L&I PROVIDER NUMBER
WA
01
—
120932
L&I PROVIDER NUMBER
WA
Enumeration date
01/03/2006
Last updated
02/05/2015
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