Provider Demographics
NPI:1437245560
Name:KELLY, TRICIA (MD)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 CETRONIA RD
Mailing Address - Street 2:SUITE 225S
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9263
Mailing Address - Country:US
Mailing Address - Phone:610-628-7000
Mailing Address - Fax:610-628-7001
Practice Address - Street 1:240 CETRONIA RD
Practice Address - Street 2:SUITE 225S
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9263
Practice Address - Country:US
Practice Address - Phone:610-628-7000
Practice Address - Fax:610-628-7001
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD066757L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60788Medicare UPIN
PA129763QKTMedicare PIN