Organization
LAWRENCE B. KELLY, MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE BENNETT KELLY M.D. (OWNER)
(304) 343-1022
Entity
Organization
Contact information
Practice address
4825 MACCORKLE AVE SW STE C, SOUTH CHARLESTON, WV 25309-1365
(304) 343-1022
(304) 343-1025
Mailing address
PO BOX 11850, CHARLESTON, WV 25339-1850
(304) 343-1022
(304) 343-1025
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720795
BLUE CROSS BLUE SHIELD
WV
05
—
3810011496
—
WV
01
—
DN1230
MEDICARE RAILROAD
WV
Enumeration date
05/04/2007
Last updated
02/09/2024
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