Individual
MRS. ALICIA PETICOLAS KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
15 FRANCIS STREET, PBB-B4, BOSTON, MA 02115
(617) 732-8003
Mailing address
3 MAPLE CT, MAYNARD, MA 01754-2342
(978) 897-1536
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
363A00000X
MA
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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