Provider Demographics
NPI:1699721787
Name:KELLY, NATASHA (MD)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 BEAVER STREET
Mailing Address - Street 2:APTA8
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-2054
Mailing Address - Country:US
Mailing Address - Phone:203-954-9412
Mailing Address - Fax:
Practice Address - Street 1:445 BEAVER ST APT A8
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2054
Practice Address - Country:US
Practice Address - Phone:203-954-9412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT57235208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery