1124214978 NPI number — MRS. BETH ANNE KELLY PA-C

Table of content: MRS. BETH ANNE KELLY PA-C (NPI 1124214978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124214978 NPI number — MRS. BETH ANNE KELLY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLY
Provider First Name:
BETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSOWSKI
Provider Other First Name:
BETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124214978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 HIGHLAND AVE
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
ABINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19001-3714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-481-6070
Provider Business Mailing Address Fax Number:
215-481-6076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1245 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
ABINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19001-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-481-6070
Provider Business Practice Location Address Fax Number:
215-481-6076
Provider Enumeration Date:
09/14/2007

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: 363A00000X , with the licence number:  MA052682 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com