Individual
KELLY MELINDA BETHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5501 OLD YORK RD, PALEY 1ST FLOOR, PHILADELPHIA, PA 19141-3018
(215) 456-7170
(215) 456-4923
Mailing address
PO BOX 8500-8735, PHILADELPHIA, PA 19178-0001
(215) 456-7000
(215) 254-3289
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD070520L
PA
2080A0000X
Pediatric Adolescent Medicine Physician
226589
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02354483
—
NY
05
—
102377102
—
PA
Enumeration date
07/29/2005
Last updated
08/28/2014
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