Individual
MATTHEW KELLEHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3333 BURNET AVE. ML 5018, CINCINNATI, OH 45229-0326
(513) 636-4315
(513) 636-7905
Mailing address
PO BOX 636256, CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 585-5504
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35.120603
OH
208000000X
Pediatrics Physician
35.120603
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100355
—
OH
Enumeration date
04/13/2010
Last updated
08/09/2017
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