Provider Demographics
NPI:1073384210
Name:LAMELZA, KELSEY (SP029047)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:LAMELZA
Suffix:
Gender:F
Credentials:SP029047
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6673 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2252
Mailing Address - Country:US
Mailing Address - Phone:215-247-2996
Mailing Address - Fax:215-247-7504
Practice Address - Street 1:6673 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2252
Practice Address - Country:US
Practice Address - Phone:215-247-2996
Practice Address - Fax:215-247-7504
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029047208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics