Provider Demographics
NPI:1982014858
Name:KRESPAN, KELLY L (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:KRESPAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W CHESTER PIKE STE 310
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2737
Mailing Address - Country:US
Mailing Address - Phone:610-446-2260
Mailing Address - Fax:610-446-3360
Practice Address - Street 1:2010 W CHESTER PIKE STE 310
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2737
Practice Address - Country:US
Practice Address - Phone:610-446-2260
Practice Address - Fax:610-446-3360
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA466893207W00000X
OH35133997207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290676Medicaid