Provider Demographics
NPI:1073877981
Name:KELLEY, ABBIE LEIGH (DO)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:LEIGH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:LEIGH
Other - Last Name:MERRIFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1861 POWDER MILL RD
Mailing Address - Street 2:ATTN MEDICAL STAFF OFFICE
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-718-2041
Mailing Address - Fax:717-741-9867
Practice Address - Street 1:1855 POWDER MILL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4723
Practice Address - Country:US
Practice Address - Phone:717-848-4800
Practice Address - Fax:717-741-9867
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017147207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA413745YFB7OtherMEDICARE PTAN