Provider Demographics
NPI:1306810296
Name:KELFER, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:KELFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:WOT 2ND FL, STE C203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-425-5446
Mailing Address - Fax:508-425-5951
Practice Address - Street 1:385 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2498
Practice Address - Country:US
Practice Address - Phone:508-425-5446
Practice Address - Fax:508-425-5951
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA70572207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110052059AMedicaid
5149681OtherCIGNA HEALTH PLAN
042472266OtherONE HEALTH PLAN
29204OtherCHILDRENS MEDICAL SECURIT
917832OtherFIRST HEALTH
042472266OtherPRIVATE HEALTHCARE SYSTEM
100010844OtherRAILROAD MEDICARE
MA3100359Medicaid
AA4012OtherHARVARD PILGRIM HEALTHCAR
J12083OtherBLUE SHIELD HMO BLUE
042472266OtherHEALTHCARE VALUE MANAGEME
29204OtherHEALTHY START
3100359OtherMEDICAID WELFARE
5692214OtherAETNA US HEALTHCARE
9900835OtherFALLON COMMUNITY HEALTH P
J12083OtherBLUE CARE ELECT
784036OtherMVP HEALTH CARE
J12083OtherBLUE SHIELD INDEMNITY
MAJ12083Medicare ID - Type Unspecified
J12083Medicare ID - Type UnspecifiedB