Provider Demographics
NPI:1770840324
Name:KELLY, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PARK LN E
Mailing Address - Street 2:#2
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1960
Mailing Address - Country:US
Mailing Address - Phone:518-463-1688
Mailing Address - Fax:
Practice Address - Street 1:27 PARK LN E
Practice Address - Street 2:#2
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1960
Practice Address - Country:US
Practice Address - Phone:518-463-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1095671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine