Provider Demographics
NPI:1750558656
Name:KELLY, ELIZABETH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2460
Mailing Address - Country:US
Mailing Address - Phone:203-573-1425
Mailing Address - Fax:203-573-8236
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2460
Practice Address - Country:US
Practice Address - Phone:203-573-1425
Practice Address - Fax:203-573-8236
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2013-01-28
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Provider Licenses
StateLicense IDTaxonomies
VA0101249724207V00000X
CT050869207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology