Individual
JOHN ROBERT KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
357 GENESEE STREET, ONEIDA SURGICAL GROUP PC, ONEIDA, NY 13421
(315) 363-8800
(315) 363-0103
Mailing address
357 GENESEE STREET, ONEIDA, NY 13421
(315) 363-8800
(315) 363-0103
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
181918
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00040192301
UNIVERA
—
01
—
00911284001
BS OF NORTHEASTERN NY
—
01
—
0100576
GHI
—
05
—
01192492
—
NY
01
—
025001
MVP
—
01
—
22160
HEALTHSOURCE HMO NY
—
01
—
5897089
AETNA US HEALTHCARE
—
Enumeration date
10/23/2006
Last updated
07/08/2007
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