Provider Demographics
NPI:1992740625
Name:ABBRESCIA, KELLY LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:ABBRESCIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1019 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-9500
Mailing Address - Country:US
Mailing Address - Phone:302-697-9396
Mailing Address - Fax:302-697-2508
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:DEPT. OF EMERGENCY MEDICINE
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-7122
Practice Address - Fax:302-744-3256
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0006878207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3261034 00Medicaid
MD3261034 00Medicaid