Provider Demographics
NPI:1477547610
Name:SIRICO-KELLY, FRANCES (DO)
Entity Type:Individual
Prefix:DR
First Name:FRANCES
Middle Name:
Last Name:SIRICO-KELLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E WILLOW GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7968
Mailing Address - Country:US
Mailing Address - Phone:215-233-0557
Mailing Address - Fax:215-233-0381
Practice Address - Street 1:805 E WILLOW GROVE AVE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7968
Practice Address - Country:US
Practice Address - Phone:215-233-0557
Practice Address - Fax:215-233-0381
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006540-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01671144Medicaid
PA624231Medicare PIN
PA01671144Medicaid