Provider Demographics
NPI:1851406813
Name:KELLY, CIARAN P (MD)
Entity Type:Individual
Prefix:
First Name:CIARAN
Middle Name:P
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:308 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2955
Mailing Address - Country:US
Mailing Address - Phone:617-667-1272
Mailing Address - Fax:
Practice Address - Street 1:BI/DEACONESS MEDICAL CTR
Practice Address - Street 2:330 BROOKLINE AVENUE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74719207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology