Provider Demographics
NPI:1740341791
Name:KELLEY, MARIE RUSHER (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:RUSHER
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2261 BAGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1108
Mailing Address - Country:US
Mailing Address - Phone:310-836-1310
Mailing Address - Fax:
Practice Address - Street 1:1200 ROSECRANS AVE STE 105
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2470
Practice Address - Country:US
Practice Address - Phone:310-335-1411
Practice Address - Fax:310-414-5775
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics