1548297930 NPI number — DR. PAUL F KELLY M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548297930 NPI number — DR. PAUL F KELLY M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KELLY

Provider First Name:

PAUL

Provider Middle Name:

F

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1548297930

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/10/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

56 FRANKLIN ST.

Provider Second Line Business Mailing Address:

3RD FLOOR

Provider Business Mailing Address City Name:

WATERBURY

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06706-1253

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

203-709-6000

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

56 FRANKLIN ST.

Provider Second Line Business Practice Location Address:

3RD FLOOR

Provider Business Practice Location Address City Name:

WATERBURY

Provider Business Practice Location Address State Name:

CT

Provider Business Practice Location Address Postal Code:

06706-1253

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

203-709-6000

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/28/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  035359 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 035359 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P407727 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 10-86502 . This is a "UHC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 4369921 . This is a "AETNA HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 01035359 . This is a "CIGNA HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 0R03179 . This is a "HEALTH NET OF NORTHEAST" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 206706 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 604583 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P00025411 . This is a "RR MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 010035359CT01 . This is a "ANTHEM BC & BS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
• Identifier: 873719 . This is a "USA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 001353599 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".