Individual
JONATHAN D KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON-SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2007-00418
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467496422
—
VA
01
—
146FE
BCBS
NC
01
—
202034
MEDCOST
NC
05
—
5906885
—
NC
01
—
810633
PARTNERS
NC
01
—
9265070
AETNA
NC
Enumeration date
06/16/2006
Last updated
08/20/2010
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