Individual
MARK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
85 SPRING ST, LACONIA, NH 03246-3113
(603) 524-7402
Mailing address
85 SPRING ST, LACONIA, NH 03246-3113
(603) 524-7402
(603) 227-7596
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
11416
NH
207Y00000X
Otolaryngology Physician
Primary
11416
NH
207YX0602X
Otolaryngic Allergy Physician
11416
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30201594
—
NH
05
—
3077628
—
NH
Enumeration date
05/04/2006
Last updated
08/31/2020
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