Individual
SUSAN MALKIN KELLY
Active
Individual
SUSAN MALKIN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
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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