Provider Demographics
NPI:1841255171
Name:KELLY, ROBERT F JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:F
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:91 STILES RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-5804
Mailing Address - Country:US
Mailing Address - Phone:603-890-4404
Mailing Address - Fax:603-893-8886
Practice Address - Street 1:138 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1509
Practice Address - Country:US
Practice Address - Phone:978-454-0941
Practice Address - Fax:978-458-0743
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA134807367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA96048OtherHARVARD PILGRIM
MANA0285OtherBCBS
MANA0285Medicare ID - Type UnspecifiedMASSACHUSETTS MEDICARE