1013945211 NPI number — DR. GEORGIA ANN KELLEY M.D.

Table of content: MRS. MAUREEN E CASEY B.A. (NPI 1023161841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013945211 NPI number — DR. GEORGIA ANN KELLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLEY
Provider First Name:
GEORGIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1013945211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06473-2365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-234-1891
Provider Business Mailing Address Fax Number:
203-234-2678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06473-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-234-1891
Provider Business Practice Location Address Fax Number:
203-234-2678
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  034092 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0488063 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010034092CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061535742 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P499703 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 01034092 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001340926 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110180478 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 340920 . This is a "CTCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0Q1536 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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