Provider Demographics
NPI:1043599269
Name:KELLY, JOHN B III (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:KELLY
Suffix:III
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5098
Mailing Address - Country:US
Mailing Address - Phone:401-885-7546
Mailing Address - Fax:401-885-6640
Practice Address - Street 1:1672 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5098
Practice Address - Country:US
Practice Address - Phone:401-885-7546
Practice Address - Fax:401-885-6640
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14907207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology