Individual
DR. KELLY A MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1200 W GODFREY AVE, PHILADELPHIA, PA 19141-3323
(215) 276-6000
Mailing address
70 E MAPLE AVE, BELLMAWR, NJ 08031-1250
(609) 933-3832
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000087
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1547286
BLUE SHIELD
PA
Enumeration date
08/04/2006
Last updated
04/05/2012
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