Provider Demographics
NPI:1639204225
Name:MARCELLO-DONNELLY, KIRSTIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTIE
Middle Name:R
Last Name:MARCELLO-DONNELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:150 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 SOUTH 11TH STREET
Practice Address - Street 2:7TH FLOOR COLLEGE BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT1823612080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine