Provider Demographics
NPI:1427056795
Name:OCALLAHAN, KELLY J (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:OCALLAHAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 CENTRAL ST
Mailing Address - Street 2:FLOOR 4
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:508-831-0708
Mailing Address - Fax:508-831-0272
Practice Address - Street 1:100 CENTRAL ST
Practice Address - Street 2:FLOOR 4
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-831-0708
Practice Address - Fax:508-831-0272
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA159560207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3201601Medicaid
MA3201601Medicaid
H05508Medicare UPIN