Provider Demographics
NPI:1760430318
Name:KELLY, MARGARET ELLEN CROTTY (RN, PNP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ELLEN CROTTY
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:54 S WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3008
Mailing Address - Country:US
Mailing Address - Phone:716-674-0988
Mailing Address - Fax:
Practice Address - Street 1:936 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1804
Practice Address - Country:US
Practice Address - Phone:716-888-1311
Practice Address - Fax:716-888-1315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380281363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY78135605Medicare UPIN
NYCC4175Medicare PIN