Provider Demographics
NPI:1447215330
Name:HERRON, KELLY A (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:HERRON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:21 WILLOW POND WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2687
Mailing Address - Country:US
Mailing Address - Phone:585-232-3210
Mailing Address - Fax:585-232-4657
Practice Address - Street 1:990 SOUTH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2763
Practice Address - Country:US
Practice Address - Phone:585-232-3210
Practice Address - Fax:585-232-4657
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-11-18
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Provider Licenses
StateLicense IDTaxonomies
NY210783-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC7127Medicare PIN