Provider Demographics
NPI:1194378455
Name:KELLY, MARGARET ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:158 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:NY
Practice Address - Zip Code:12188-2205
Practice Address - Country:US
Practice Address - Phone:518-233-1162
Practice Address - Fax:518-233-0903
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2024-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00533500207Q00000X
NY032868363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine