Provider Demographics
NPI:1073773578
Name:KELLY, LAWRENCE WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE, HSC, L-4, ROOM 080
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-3880
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE, HSC, L-4, ROOM 080
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-3880
Practice Address - Fax:631-444-6031
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-08-04
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Provider Licenses
StateLicense IDTaxonomies
NY257499207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine