Provider Demographics
NPI:1811491731
Name:KELLETT, ERIC THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:THOMAS
Last Name:KELLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEALTHCARE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9445
Mailing Address - Country:US
Mailing Address - Phone:207-282-3666
Mailing Address - Fax:
Practice Address - Street 1:9 HEALTHCARE DR STE 105
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9445
Practice Address - Country:US
Practice Address - Phone:207-282-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD28294207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease