Provider Demographics
NPI:1316058837
Name:KELLETT, BARTO PAUL (MD)
Entity type:Individual
Prefix:MR
First Name:BARTO
Middle Name:PAUL
Last Name:KELLETT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:RELIANT GERIATRICS
Mailing Address - Street 2:P.O. BOX 14611
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29610-4611
Mailing Address - Country:US
Mailing Address - Phone:864-306-0966
Mailing Address - Fax:864-306-2544
Practice Address - Street 1:RELIANT GERIATRICS
Practice Address - Street 2:3523 PELHAM RD, SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4191
Practice Address - Country:US
Practice Address - Phone:864-306-0966
Practice Address - Fax:864-306-2544
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-11-21
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Provider Licenses
StateLicense IDTaxonomies
SC8851207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC088513Medicaid
SC88513Medicaid