Provider Demographics
NPI:1235133281
Name:HAYES, KELLY L (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:HAYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 2ND ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-456-8980
Mailing Address - Fax:814-451-0443
Practice Address - Street 1:120 E 2ND ST FL 2
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-456-8980
Practice Address - Fax:814-451-0443
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-085317207RC0001X
NY234504-1207RC0001X
PAMD423957207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101086460Medicaid
PA078832Medicare ID - Type Unspecified