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Individual

KELLY KIRSTEN O'MALIA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
6265 STATE ROUTE 45, BRISTOLVILLE, OH 44402
(330) 889-9009
(330) 889-9278
Mailing address
6265 STATE ROUTE 45, PO BOX 280, BRISTOLVILLE, OH 44402-0280
(330) 889-9009
(330) 889-9278

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35073030
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000284981
ANTHEM BLUE CROSS BLUE SH
OH
05
2122385
OH
01
5300780
AETNA
OH
01
835645
CIGNA
OH
01
PO0020658
RAILROAD MEDICARE
OH
Enumeration date
05/31/2005
Last updated
02/11/2009
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