Provider Demographics
NPI:1104861343
Name:KELLY, JAMES M (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LARKSPUR LANE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8402
Mailing Address - Country:US
Mailing Address - Phone:717-738-0660
Mailing Address - Fax:717-738-0658
Practice Address - Street 1:101 LARKSPUR LANE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-8402
Practice Address - Country:US
Practice Address - Phone:717-738-0660
Practice Address - Fax:717-738-0658
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50061893OtherCAPITAL BLUE CROSS
PA7276819OtherAETNA NON-HMO
PA1874597OtherHIGHMARK BLUE SHIELD
PA50065832OtherCAPITAL BLUE CROSS
PA50061968OtherCAPITAL BLUE CROSS
PA50060203OtherCAPITAL BLUE CROSS
PA1016458260001Medicaid
PA107754 S1QFOtherGEISINGER HEALTH PLAN
PA1429961OtherAETNA HMO
PAI54742OtherHEALTH ASSURANCE
PAP008054OtherGATEWAY HEALTH PLAN
PA107754 S1QFOtherGEISINGER HEALTH PLAN
PA50065832OtherCAPITAL BLUE CROSS
PAI54742Medicare UPIN
PA102011JZEMedicare PIN