Provider Demographics
NPI:1417910977
Name:KELLY, DOROTHY H (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:H
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 1:260 NEW LUDLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4324
Mailing Address - Country:US
Mailing Address - Phone:413-533-3470
Mailing Address - Fax:413-533-6859
Practice Address - Street 1:18 HOSPITAL DR
Practice Address - Street 2:D/B/A: WESTERN MASS PEDIATRICS
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6606
Practice Address - Country:US
Practice Address - Phone:413-534-2800
Practice Address - Fax:413-534-2801
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12937208000000X
MA36427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110036951AMedicaid
MA110036951AMedicaid