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Individual

SUSAN MALKIN KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
75 MOUNT AUBURN ST, CAMBRIDGE, MA 02138-4960
(617) 495-2323
Mailing address
75 MOUNT AUBURN ST, CAMBRIDGE, MA 02138-4960
(617) 495-2323

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
207990
MA
2084P0800X
Psychiatry Physician
DR.0060891
CO
2084P0800X
Psychiatry Physician
MD10480
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
007010632
MEDICARE ID-TYPE UNSPECIFIED
RI
01
1093831646
BUTLER HOSPITAL PROFESSIONAL BILLING OFFICE NPI
01
1104801349
BUTLER HOSPITAL NPI
RI
01
24196-0
BLUE CROSS
RI
01
410419
BLUE CHIP
RI
05
SK37242
RI
Enumeration date
07/06/2006
Last updated
03/17/2021
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