Provider Demographics
NPI:1720235997
Name:BIGGS, KELLY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:WILLIAM
Last Name:BIGGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:131 TREETOPS DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2574
Mailing Address - Country:US
Mailing Address - Phone:814-308-8623
Mailing Address - Fax:814-308-8311
Practice Address - Street 1:187 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1808
Practice Address - Country:US
Practice Address - Phone:814-684-1255
Practice Address - Fax:814-682-1804
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4371982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABI2509742OtherBLUE SHIELD
PA102472424-0001Medicaid
PA102472424-0001Medicaid