Individual
KELSEY A. EGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
840 HARRISON AVE # MENINO4, BOSTON, MA 02118-2905
(617) 414-4511
(617) 414-3171
Mailing address
720 HARRISON AVE # DOB503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
278435
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110116725A
—
MA
Enumeration date
03/27/2016
Last updated
08/15/2019
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