Provider Demographics
NPI:1558394874
Name:KELS, BARRY DANA (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:DANA
Last Name:KELS
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 1:19 WOODLAND ST
Mailing Address - Street 2:SUITE 41
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2372
Mailing Address - Country:US
Mailing Address - Phone:860-249-2020
Mailing Address - Fax:860-246-7549
Practice Address - Street 1:19 WOODLAND ST
Practice Address - Street 2:SUITE 41
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2372
Practice Address - Country:US
Practice Address - Phone:860-249-2020
Practice Address - Fax:860-246-7549
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021553174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010021553CT01OtherBC/BS PROVIDER ID
CT83840OtherAETNA PROVIDER ID
CT0S2291OtherHEALTH NET PROVIDER ID
CT079001OtherCONNECTICARE PROVIDER ID
CTHAS281OtherOXFORD PROVIDER ID
CT001215532Medicaid
CT0S2291OtherHEALTH NET PROVIDER ID
CTB83807Medicare UPIN