Provider Demographics
NPI:1194378455
Name:KELLY, MARGARET ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 GROVE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1731
Mailing Address - Country:US
Mailing Address - Phone:973-239-2600
Mailing Address - Fax:973-239-0482
Practice Address - Street 1:271 GROVE AVE STE A
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1731
Practice Address - Country:US
Practice Address - Phone:973-239-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00533500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine