Provider Demographics
NPI:1851303978
Name:KELLEY, MARK AIDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:AIDAN
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2573 STANTONSBURG RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7213
Mailing Address - Country:US
Mailing Address - Phone:252-215-5200
Mailing Address - Fax:252-215-0623
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:SUITE 301
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8634
Practice Address - Country:US
Practice Address - Phone:734-572-4500
Practice Address - Fax:734-572-4529
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301091561207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1851303978Medicaid
F27060Medicare UPIN