Provider Demographics
NPI:1801863568
Name:KELLY, TERRY (PA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DUPLAINVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9020
Mailing Address - Country:US
Mailing Address - Phone:518-581-4900
Mailing Address - Fax:
Practice Address - Street 1:56 DUPLAINVILLE RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9020
Practice Address - Country:US
Practice Address - Phone:518-581-4900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004085-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine