Individual
DAVID LEE KELLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-2907
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-2907
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
11526
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204068000
—
WV
01
—
26310
MEDCOST
NC
01
—
2875
PARTNERS
NC
01
—
4382149
AETNA
NC
01
—
48205
BCBS
NC
05
—
6133801
—
VA
05
—
8948205
—
NC
05
—
Q11526
—
SC
Enumeration date
01/13/2006
Last updated
08/20/2010
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