Provider Demographics
NPI:1295759496
Name:KELLING, ERNEST COLLYER (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:COLLYER
Last Name:KELLING
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 1:52 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-1814
Mailing Address - Country:US
Mailing Address - Phone:914-666-3320
Mailing Address - Fax:914-666-3340
Practice Address - Street 1:52 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-1814
Practice Address - Country:US
Practice Address - Phone:914-666-3320
Practice Address - Fax:914-666-3340
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR76442085R0202X
CO367432085R0202X
WI42244-202085R0202X
GA0573852085R0202X
MI43010869832085R0202X
TNMD00000393202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52173036002OtherBCBS
GA825971709AMedicaid
AL60043290OtherBCBS
AL60043290OtherBCBS