Provider Demographics
NPI:1821182221
Name:KELLY, ROSEMARY HELENA (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:HELENA
Last Name:KELLY
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 1:2812 E MADISON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4863
Mailing Address - Country:US
Mailing Address - Phone:206-329-0816
Mailing Address - Fax:206-329-0916
Practice Address - Street 1:2812 E MADISON ST STE 3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4863
Practice Address - Country:US
Practice Address - Phone:206-329-0816
Practice Address - Fax:206-329-0916
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAM000384412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG01104Medicare UPIN