Individual
DR. TIMOTHY J KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 S HERLONG AVE, SUITE A, ROCK HILL, SC 29732-3399
(803) 328-1864
(803) 328-1865
Mailing address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
(704) 295-3468
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
30274
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1506232
COVENTRY
—
05
—
302746
—
SC
01
—
AA21828218
MEDICARE
SC
01
—
P01505878
RAILROAD MEDICARE
SC
Enumeration date
01/03/2007
Last updated
04/26/2021
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