Individual
SEAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
123 MEDICAL CENTER DR, BRUNSWICK, ME 04011-2652
(207) 373-1025
(207) 373-1026
Mailing address
324 GANNETT DRIVE SUITE 200, SOUTH PORTLAND, ME 04106
(207) 482-7800
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD14937
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041366
ANTHEM BLUE CROSS
ME
01
—
050092018
RAILROAD MEDICARE
ME
05
—
195860099
—
ME
Enumeration date
10/17/2006
Last updated
06/29/2017
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