Provider Demographics
NPI:1164491957
Name:KELLY, SARA F (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:F
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:111 GROSSMAN DR
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4997
Mailing Address - Country:US
Mailing Address - Phone:781-849-2400
Mailing Address - Fax:781-849-2238
Practice Address - Street 1:111 GROSSMAN DR
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4997
Practice Address - Country:US
Practice Address - Phone:781-849-2400
Practice Address - Fax:781-849-2238
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA60341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3044131Medicaid
MAJ07599OtherBLUE CROSS
MA731520OtherTUFTS
MAPM671OtherHARVARD PILGRIM
MAPM671OtherHARVARD PILGRIM
MA3044131Medicaid