Individual
MARK A. KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6 KENT AVE, MARSHFIELD, MA 02050
(248) 521-7181
Mailing address
6 KENT AVE, MARSHFIELD, MA 02050-3079
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
076453
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
076453
MI
207RP1001X
Pulmonary Disease Physician
Primary
076453
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290H264420
BLUE CROSS-BLUE CROSS
—
05
—
425232910
—
MI
01
—
MK076453
CHAMPUS-CHAMPUS
—
Enumeration date
12/01/2006
Last updated
05/06/2019
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