Individual
DR. GREGORY DENNIS KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1400 HOSPITAL DR, EMERGENCY DEPARTMENT, HURRICANE, WV 25526-9202
(304) 757-1767
(304) 757-1716
Mailing address
1400 HOSPITAL DR, HURRICANE, WV 25526-9202
(800) 875-0136
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
744
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000681385
BLUE CROSS BLUE SHIELD
WV
01
—
0050063000
WV MEDICAID
WV
01
—
1052927
WV DWC
WV
Enumeration date
11/07/2006
Last updated
01/10/2017
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