Provider Demographics
NPI:1326349200
Name:TIMOTHY F. KELLY,M.D., P.A.
Entity Type:Organization
Organization Name:TIMOTHY F. KELLY,M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-712-8222
Mailing Address - Street 1:1840 MEASE DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6602
Mailing Address - Country:US
Mailing Address - Phone:727-712-8222
Mailing Address - Fax:727-712-8229
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 406
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-712-8222
Practice Address - Fax:727-712-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27044Medicare UPIN
FL79740Medicare PIN