Provider Demographics
NPI:1639318835
Name:THOMAS F. KELLY, MD, PA
Entity Type:Organization
Organization Name:THOMAS F. KELLY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-365-9411
Mailing Address - Street 1:1880 ARLINGTON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3524
Mailing Address - Country:US
Mailing Address - Phone:941-365-9411
Mailing Address - Fax:941-365-9414
Practice Address - Street 1:1880 ARLINGTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3524
Practice Address - Country:US
Practice Address - Phone:941-365-9411
Practice Address - Fax:941-365-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68149Medicare PIN
FLE3475XMedicare PIN