Individual
MR. JOHN J KELLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCO
Contact information
Practice address
1107 KENILWORTH DR, SUITE 310, TOWSON, MD 21204-2140
(410) 828-5628
(419) 828-5629
Mailing address
1107 KENILWORTH DR, SUITE 310, TOWSON, MD 21204-2140
(410) 828-5628
(419) 828-5629
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
—
246Z00000X
Other Specialist/Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52455501
BC BS REGION
MD
01
—
Y391
FED BC BS
MD
Enumeration date
11/20/2006
Last updated
03/28/2008
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