Provider Demographics
NPI:1073523544
Name:KELLY, LAWRENCE P (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-0743
Mailing Address - Country:US
Mailing Address - Phone:631-734-7184
Mailing Address - Fax:631-734-7186
Practice Address - Street 1:25270 MAIN RD
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1286
Practice Address - Country:US
Practice Address - Phone:631-734-7184
Practice Address - Fax:631-734-7186
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY152310208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY69D801Medicare ID - Type Unspecified
C11890Medicare UPIN