Provider Demographics
NPI:1700836244
Name:LEITE, KELLY R (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:LEITE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:35 HOPE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2086
Practice Address - Country:US
Practice Address - Phone:717-531-7300
Practice Address - Fax:717-531-3527
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009022L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015194250010Medicaid
PA0015194250010Medicaid
G14357Medicare UPIN