Provider Demographics
NPI:1417118506
Name:SCOLLON-GRIEVE, KELLY L (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:SCOLLON-GRIEVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:SCOLLON GRIEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:525 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083
Mailing Address - Country:US
Mailing Address - Phone:610-789-7767
Mailing Address - Fax:610-789-7768
Practice Address - Street 1:525 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 203
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:610-789-7767
Practice Address - Fax:610-789-7768
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441928208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation