Provider Demographics
NPI:1033150701
Name:KELLEY, NEAL CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:CHRISTOPHER
Last Name:KELLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:68 CUMBERLAND ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3323
Mailing Address - Country:US
Mailing Address - Phone:401-762-3838
Mailing Address - Fax:401-762-8252
Practice Address - Street 1:68 CUMBERLAND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3323
Practice Address - Country:US
Practice Address - Phone:401-762-3838
Practice Address - Fax:401-762-8252
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040596207RC0000X
RIMD12066207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7058561Medicaid
RII54135Medicare UPIN
RI069006280Medicare PIN
RIP00327565Medicare PIN
RI007060843Medicare PIN