Individual
DR. MICHAEL ANTHONY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1710 HARPER RD, BECKLEY, WV 25801-3357
(304) 254-3101
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
13535
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0050014000
—
WV
01
—
011906S46
MEDICARE VA
VA
01
—
1008977
WORKERS COMP
WV
01
—
P00287045
RAILROAD MEDICARE
VA
01
—
P00397732
RAILROAD MEDICARE
VA
01
—
P00397732
MEDICARE RAILROAD
WV
05
—
PENDING
—
WV
Enumeration date
06/21/2006
Last updated
11/29/2007
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