Provider Demographics
NPI:1528252962
Name:HELENA H KELLIHER MD
Entity type:Organization
Organization Name:HELENA H KELLIHER MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:H
Authorized Official - Last Name:KELLIHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-829-4461
Mailing Address - Street 1:52 BOYDEN RD
Mailing Address - Street 2:STE 206
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2592
Mailing Address - Country:US
Mailing Address - Phone:508-829-4461
Mailing Address - Fax:508-829-6244
Practice Address - Street 1:52 BOYDEN RD
Practice Address - Street 2:STE 206
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-2592
Practice Address - Country:US
Practice Address - Phone:508-829-4461
Practice Address - Fax:508-829-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9769528Medicaid