Provider Demographics
NPI:1356363402
Name:KELLEY, GERALDINE K (MD)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:K
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6300 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3216
Mailing Address - Country:US
Mailing Address - Phone:716-667-3222
Mailing Address - Fax:716-667-3213
Practice Address - Street 1:6300 POWERS RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-3216
Practice Address - Country:US
Practice Address - Phone:716-667-3222
Practice Address - Fax:716-667-3213
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-12-07
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Provider Licenses
StateLicense IDTaxonomies
NY131207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044122000033OtherFIDELIS
NY010125493OtherRAILROAD MEDICARE
NY000508144006OtherBLUE CROSS OF WNY
NY0406891OtherINDEPENDENT HEALTH
NY0406891OtherINDEPENDENT HEALTH
NY010125493OtherRAILROAD MEDICARE