Provider Demographics
NPI:1306818497
Name:MCKELVEY, ALICIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ANN
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 280 LANKENAU MED SCI BLDG.
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-527-0404
Mailing Address - Fax:610-527-0824
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 280 LANKENAU MED SCI BLDG.
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-527-0404
Practice Address - Fax:610-527-0824
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT042616174400000X, 208G00000X
PAMD425541208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2359401OtherMLHC TAX ID
CT330000137Medicare UPIN
PA23-2359401OtherMLHC TAX ID
PA164339HK1Medicare PIN
CT780000039Medicare PIN