Provider Demographics
NPI:1477580363
Name:SPRATT, KELLY ANNE (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:SPRATT
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 1:51NORTH 39TH STREET
Mailing Address - Street 2:PHI, SUITE 2C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-9010
Mailing Address - Fax:215-662-9733
Practice Address - Street 1:51 NORTH 39TH STREET
Practice Address - Street 2:PHI, SUITE 2C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-9010
Practice Address - Fax:215-662-9733
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S006513L207RC0000X
PAOS006513L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011675290008Medicaid
PA444646Medicare PIN
PA0011675290008Medicaid