Individual
MARYBETH S KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
75 SPRINGFIELD RD, SUITE 1 FAMILY MEDICINE ASSOC, WESTFIELD, MA 01085
(413) 562-5173
(413) 562-1716
Mailing address
75 SPRINGFIELD RD, SUITE 1 FAMILY MEDICINE ASSOC, WESTFIELD, MA 01085
(413) 562-5173
(413) 562-1716
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1150
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011500
CONNECTICARE OF MA
—
01
—
21237210422
BEECH STREET
—
Enumeration date
07/21/2005
Last updated
01/03/2008
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