Provider Demographics
NPI:1659875540
Name:O'CONNOR, KELLY (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 INNOVATION DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8000
Mailing Address - Country:US
Mailing Address - Phone:217-433-2804
Mailing Address - Fax:888-977-2896
Practice Address - Street 1:75 WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1795
Practice Address - Country:US
Practice Address - Phone:781-878-6495
Practice Address - Fax:781-878-7650
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA295157207N00000X
MA280743390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program