Provider Demographics
NPI:1235110883
Name:ROVEDA, KELLY POWERS (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:POWERS
Last Name:ROVEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KELLY
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-471-7790
Mailing Address - Fax:251-471-7715
Practice Address - Street 1:2451 FILLINGIM STREET
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7790
Practice Address - Fax:251-471-7715
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16954207ZC0006X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000203045Medicaid
ALG04134Medicare UPIN
AL0000203045Medicaid