Provider Demographics
NPI:1205080850
Name:KELLY, PETER HAMILTON (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HAMILTON
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776A WATERVLIET SHAKER RD
Mailing Address - Street 2:ACCESS HEALTH SYSTEMS
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110
Mailing Address - Country:US
Mailing Address - Phone:518-782-2200
Mailing Address - Fax:
Practice Address - Street 1:776A WATERVLIET SHAKER RD
Practice Address - Street 2:ACCESS HEALTH SYSTEMS
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-782-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135828207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services