Provider Demographics
NPI:1194766394
Name:KELLY, WILLIAM FRANCIS (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FRANCIS
Last Name:KELLY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5100 BUCKEYSTOWN PIKE
Mailing Address - Street 2:SUITE 186
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8336
Mailing Address - Country:US
Mailing Address - Phone:301-682-8888
Mailing Address - Fax:301-682-3515
Practice Address - Street 1:5100 BUCKEYSTOWN PIKE
Practice Address - Street 2:SUITE 186
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8336
Practice Address - Country:US
Practice Address - Phone:301-682-8888
Practice Address - Fax:301-682-3515
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC00389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP19275Medicare UPIN
MDKR7021SSMedicare ID - Type Unspecified