Provider Demographics
NPI:1508818709
Name:KELLY, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:KELLY
Suffix:
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 1:1235 OLD YORK RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3800
Mailing Address - Country:US
Mailing Address - Phone:215-481-6350
Mailing Address - Fax:215-481-6359
Practice Address - Street 1:1235 OLD YORK RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3800
Practice Address - Country:US
Practice Address - Phone:215-481-6350
Practice Address - Fax:215-481-6359
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028707E207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease