Provider Demographics
NPI:1437184454
Name:KELLY, PAUL F (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1702
Mailing Address - Country:US
Mailing Address - Phone:781-979-0661
Mailing Address - Fax:781-979-0372
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 216
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-979-0661
Practice Address - Fax:781-979-0372
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA28299208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM07461OtherBCBS
MA0161373Medicaid
MA340005508OtherRR MEDICARE
MAM07461Medicare UPIN