Provider Demographics
NPI:1275706160
Name:KELLEHER, ERIN PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:PATRICIA
Last Name:KELLEHER
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 1:222 WESTCHESTER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2926
Mailing Address - Country:US
Mailing Address - Phone:914-761-1717
Mailing Address - Fax:914-761-1711
Practice Address - Street 1:222 WESTCHESTER AVE STE 202
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2926
Practice Address - Country:US
Practice Address - Phone:914-761-1717
Practice Address - Fax:914-761-1711
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117482208000000X
NY290035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009949200Medicaid