Individual
DR. CHARLES JUDE KELLY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 MEDICAL VILLAGE DR, SUITE 102, EDGEWOOD, KY 41017-5401
(859) 341-1011
(859) 341-7198
Mailing address
20 MEDICAL VILLAGE DR, SUITE 102, EDGEWOOD, KY 41017-5401
(859) 341-1011
(859) 341-7198
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
34229
KY
208000000X
Pediatrics Physician
35 07 8628
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000175988
ANTHEM
—
01
—
1202784
UNITED HEALTH CARE OF OHI
—
01
—
2501317
AETNA
—
05
—
64013543
—
KY
01
—
7499170002
CIGNA
—
Enumeration date
02/09/2006
Last updated
07/08/2007
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