Provider Demographics
NPI:1225020225
Name:MOORHEAD, KELLY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:MOORHEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:470 WHITE POND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1185
Mailing Address - Country:US
Mailing Address - Phone:330-869-8530
Mailing Address - Fax:330-869-8539
Practice Address - Street 1:470 WHITE POND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1185
Practice Address - Country:US
Practice Address - Phone:330-869-8530
Practice Address - Fax:330-869-8539
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-073029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH2269138Medicaid
OHH12549Medicare UPIN
OH2269138Medicaid