Provider Demographics
NPI:1972633345
Name:KAREN M. KELLY M.D.,P.A.
Entity Type:Organization
Organization Name:KAREN M. KELLY M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-994-8887
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5400
Mailing Address - Country:US
Mailing Address - Phone:302-994-8887
Mailing Address - Fax:302-994-8208
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-994-8887
Practice Address - Fax:302-994-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000562301Medicaid
DEKE41885Medicare ID - Type Unspecified
DE0000562301Medicaid