Provider Demographics
NPI:1437181021
Name:KELLETT, MARIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LYNN
Last Name:KELLETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:LYNN
Other - Last Name:VANDEN BOSCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:116 S GEORGE ST
Mailing Address - Street 2:STE 301
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-1443
Mailing Address - Country:US
Mailing Address - Phone:717-801-4821
Mailing Address - Fax:717-854-0377
Practice Address - Street 1:116 S GEORGE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-1474
Practice Address - Country:US
Practice Address - Phone:717-801-4821
Practice Address - Fax:717-854-0377
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069128L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001796416Medicaid
PA2114706OtherMAMSI-WMG
PA100454OtherGEISINGER
PA20145139OtherCAPITAL BLUE CROSS
PA422755OtherHIGHMARK BLUE SHIELD
PA037277EBXMedicaid
PA30261433OtherAMERIHEALTH CARITAS
PA7745873OtherAETNA
PA037277EBXMedicaid
PA30123030 - RDYCAREOtherAMERIHEALTH MERCY - WMG
PA30152925OtherAMERIHEALTH CARITAS PA - WMG - THFPC
PAP002715OtherGATEWAY-WMG
PA142186OtherUNISON-WMG
PAP00012791Medicare PIN
MD620754OtherCAREFIRST MD BCBS
PA2114706OtherMAMSI-WMG
PA50018571OtherCAPITAL BLUE CROSS-WMG
PA037277FLTMedicare PIN