Provider Demographics
NPI:1407932304
Name:KELTY, PATRICK JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:KELTY
Suffix:
Gender:M
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:PO BOX 3445
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-3445
Mailing Address - Country:US
Mailing Address - Phone:828-322-2050
Mailing Address - Fax:828-345-0522
Practice Address - Street 1:2424 CENTURY PL SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4031
Practice Address - Country:US
Practice Address - Phone:828-322-2050
Practice Address - Fax:828-345-0522
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00787207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1853484OtherWELLCARE
NC5911876Medicaid
NC154J4OtherBCBS
NC9179378OtherENVOLVE
NC1407932304Medicaid
11980296OtherCAQH
NCA03453OtherEYEMED
NC9179378OtherAETNA