Organization
IAN A KELLMAN MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IAN KELLMAN MD (OWNER)
(570) 988-0925
Entity
Organization
Contact information
Practice address
880 STATE RT. 6 W, TYLER MEM HOSP, TUNKHANNOCK, PA 18657
(570) 988-0925
(570) 988-0919
Mailing address
PO BOX 246, DALLAS, PA 18612-0246
(570) 988-0925
(570) 988-0919
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018508240002
—
PA
01
—
CJ9716
RAIL ROAD MEDICARE
PA
Enumeration date
05/08/2006
Last updated
07/23/2008
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