Provider Demographics
NPI:1215054028
Name:KELLY, VERNON CHARLES JR (MD)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:CHARLES
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7948 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8533
Mailing Address - Country:US
Mailing Address - Phone:215-836-5465
Mailing Address - Fax:610-896-5540
Practice Address - Street 1:7948 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-8533
Practice Address - Country:US
Practice Address - Phone:215-836-5465
Practice Address - Fax:610-896-5540
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033301L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry