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Individual

ELIZABETH KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON-SALEM, NC 27157-0001
(336) 716-2255
(336) 716-5438
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-5438

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2007-00462
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
146FA
BCBS
NC
05
1609957174
VA
01
202033
MEDCOST
NC
05
5906823
NC
01
810632
PARTNERS
NC
01
9539075
AETNA
Enumeration date
10/18/2006
Last updated
08/20/2010
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