Provider Demographics
NPI:1346400991
Name:KELLY, MEREDITH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:ANN
Last Name:KELLY
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 1:681 OAK GROVE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4333
Mailing Address - Country:US
Mailing Address - Phone:650-229-8420
Mailing Address - Fax:855-450-0855
Practice Address - Street 1:681 OAK GROVE AVE STE B
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4333
Practice Address - Country:US
Practice Address - Phone:650-229-8420
Practice Address - Fax:855-450-0855
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1312552084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine