Individual
JOHANNA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
40 BERKSHIRE CT, WYOMISSING, PA 19610-1224
(610) 374-7400
(610) 374-4252
Mailing address
40 BERKSHIRE CT, WYOMISSING, PA 19610-1224
(610) 374-7400
(610) 374-4252
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD063346L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1661845
—
PA
Enumeration date
04/04/2006
Last updated
08/12/2010
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