Provider Demographics
NPI:1326058181
Name:KELLY, RAYMOND (DO)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4501
Mailing Address - Country:US
Mailing Address - Phone:978-783-5000
Mailing Address - Fax:978-313-8184
Practice Address - Street 1:323 LOWELL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-783-5000
Practice Address - Fax:978-313-8184
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA275150207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0107100Y0NH02OtherANTHEM
NH30008650Medicaid
AA86677OtherHARVARD PILGRIM
NHP00457777OtherRAILROAD MEDICARE
000000042886OtherBMC HEALTHNET PLAN
MA0118842Medicaid
930055342OtherRAILROAD MEDICARE
ME271040099Medicaid
3428550OtherCIGNA
MA0118842Medicaid
NHP00457777OtherRAILROAD MEDICARE
930055342OtherRAILROAD MEDICARE