Provider Demographics
NPI:1659303634
Name:KELLY, JOHN J III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:KELLY
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:ONE CENTURIAN DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4168
Mailing Address - Country:US
Mailing Address - Phone:302-366-8600
Mailing Address - Fax:302-366-5646
Practice Address - Street 1:ONE CENTURIAN DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4168
Practice Address - Country:US
Practice Address - Phone:302-366-8600
Practice Address - Fax:302-366-5646
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-02-13
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Provider Licenses
StateLicense IDTaxonomies
DEC10004657207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEE86931Medicare UPIN
DE820197C71Medicare PIN