Provider Demographics
NPI:1588984819
Name:FRICK, KELLY M (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:FRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:MCGLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:282 THE GRN
Mailing Address - Street 2:LAUREL HALL
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19716-0009
Mailing Address - Country:US
Mailing Address - Phone:302-831-2226
Mailing Address - Fax:302-831-6407
Practice Address - Street 1:282 THE GRN
Practice Address - Street 2:LAUREL HALL
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-0009
Practice Address - Country:US
Practice Address - Phone:302-831-2226
Practice Address - Fax:302-831-6407
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0004540207Q00000X
DEC1-0010404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine