Provider Demographics
NPI:1427029545
Name:KELLY, JAMES THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:26908 COOK RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3548
Mailing Address - Country:US
Mailing Address - Phone:440-414-9700
Mailing Address - Fax:216-201-5584
Practice Address - Street 1:26908 COOK RD
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-3548
Practice Address - Country:US
Practice Address - Phone:440-414-9700
Practice Address - Fax:216-201-5584
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080144355OtherRAIL ROAD MEDICARE
OHF57401OtherSUMMA
OH0885190Medicaid
OH000000128714OtherANTHEM
OH0885190Medicaid
OH000000128714OtherANTHEM