Individual
TIMOTHY G KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1915 TRADD CT, WILMINGTON, NC 28401-6638
(910) 762-0057
(910) 762-0336
Mailing address
1915 TRADD COURT, WILMINGTON, NC 28401-6638
(910) 762-0057
(910) 762-0336
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
33074
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0210J
BCBS
NC
01
—
0838871
UNITED HEALTHCARE
NC
05
—
890210J
—
NC
Enumeration date
05/31/2005
Last updated
10/18/2013
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