Provider Demographics
NPI:1427158377
Name:KELTY, PAUL D (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:KELTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EDSEL LN NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2168
Mailing Address - Country:US
Mailing Address - Phone:812-738-8207
Mailing Address - Fax:812-738-1076
Practice Address - Street 1:2000 EDSEL LN NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2168
Practice Address - Country:US
Practice Address - Phone:812-738-8207
Practice Address - Fax:812-738-1076
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029084A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0000042440OtherANTHEM
KY64755101Medicaid
IN100128130AMedicaid
KY1111620OtherPASSPORT HEALTH PLANS
KY1111620OtherPASSPORT HEALTH PLANS
KY64755101Medicaid
IN0000042440OtherANTHEM