Provider Demographics
NPI:1487674115
Name:KELLY, FRANCIS WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:WILLIAM
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 STATE ROUTE 19 N
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-9334
Mailing Address - Country:US
Mailing Address - Phone:585-786-2010
Mailing Address - Fax:585-786-2058
Practice Address - Street 1:2261 STATE ROUTE 19 N
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9334
Practice Address - Country:US
Practice Address - Phone:585-786-2010
Practice Address - Fax:585-786-2058
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01799435Medicaid
NY01799435Medicaid
NYBB0545Medicare ID - Type Unspecified