Provider Demographics
NPI: | 1487635173 |
---|---|
Name: | KELLY, CYNTHIA M (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | CYNTHIA |
Middle Name: | M |
Last Name: | KELLY |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 4900 S MONACO ST |
Mailing Address - Street 2: | SUITE 210 |
Mailing Address - City: | DENVER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80237-3486 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-837-0072 |
Mailing Address - Fax: | 303-837-0075 |
Practice Address - Street 1: | 1601 E 19TH AVE |
Practice Address - Street 2: | SUITE 3300 |
Practice Address - City: | DENVER |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80218-1216 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-837-0072 |
Practice Address - Fax: | 303-837-0075 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-11-09 |
Last Update Date: | 2022-02-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 34692 | 207X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WY | 115017100 | Medicaid | |
NE | 1245556091 | Medicaid | |
NM | 28887280 | Medicaid | |
CO | 01346923 | Medicaid | |
NM | 28887280 | Medicaid | |
CO | COA102909 | Medicare PIN | |
NE | 1245556091 | Medicaid | |
CO | 01346923 | Medicaid |