Provider Demographics
NPI:1578797668
Name:KELLY, AMY MARIE (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-6560
Mailing Address - Fax:814-372-2848
Practice Address - Street 1:757 JOHNSONBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3488
Practice Address - Country:US
Practice Address - Phone:814-788-8580
Practice Address - Fax:814-788-8018
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2016-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOT013046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARES000Medicare UPIN