Provider Demographics
NPI:1275637795
Name:KELLEY, SUZANNE KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:KAY
Last Name:KELLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4295 MARYLAND CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9115
Mailing Address - Country:US
Mailing Address - Phone:717-545-8052
Mailing Address - Fax:717-545-8052
Practice Address - Street 1:3721 TECPORT DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-1219
Practice Address - Country:US
Practice Address - Phone:717-540-6777
Practice Address - Fax:717-671-2459
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003971L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine