Provider Demographics
NPI:1093940546
Name:WILLIAMS, KELLY E (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5 MORGAN HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2641
Mailing Address - Country:US
Mailing Address - Phone:570-344-3788
Mailing Address - Fax:570-969-9280
Practice Address - Street 1:5 MORGAN HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2641
Practice Address - Country:US
Practice Address - Phone:570-344-3788
Practice Address - Fax:570-969-9280
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT013735208100000X
PAOS017241208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102967539-0001Medicaid
PA1093940546OtherUHC COMMERCIAL & MEDICARE
PA4866356OtherAETNA
PAP01389864OtherRR MEDICARE
PA30212590OtherAMERIHEALTH CARITAS
PA6620630OtherCIGNA
PA003115409OtherBLUE SHIELD/PREMIER BLUE/MEDICARE ADVANTAGE/FIRST PRIORITY LIFE
PA25-1645055OtherAETNA BETTER HEALTH
PA1093940546OtherGHP
PA1093940546OtherHEALTH AMERICA
PA833606OtherFPH
PA1093940546OtherUHC COMMERCIAL & MEDICARE