Provider Demographics
NPI:1013043314
Name:KELLEY, LEAH MORTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MORTON
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1350 S ELISEO DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2011
Mailing Address - Country:US
Mailing Address - Phone:415-925-5035
Mailing Address - Fax:415-462-7035
Practice Address - Street 1:1350 S ELISEO DR
Practice Address - Street 2:SUITE 210
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2011
Practice Address - Country:US
Practice Address - Phone:415-925-5035
Practice Address - Fax:415-462-7035
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89531207V00000X, 208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN