| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JOHN THOMAS KELLY | 1164758892 | 2023-03-13 |
John Thomas Kelly is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1164758892. Registration indicates John Thomas Kelly is a provider of access to adult/geriatric primary care providers services with a specialization in Allopathic & Osteopathic Physicians, General Practice Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, General Practice) (Allopathic & Osteopathic Physicians, General Practice) (General Practice, ) (Primary Care/Family Planning/APRN/PA, ) (General Practice, Allopathic & Osteopathic Physicians)
| Entity Type | Individual |
| Provider Name | Dr. John Thomas Kelly M.D. |
| Practice Office Address | 175 BLOSSOM ST UNIT 1407 BOSTON, MA US |
| Practice Office Telephone | 2155274684 |
| Mailing Address | 175 BLOSSOM ST UNIT 1407 BOSTON, MA 021142629 US |
| Business Telephone | 2155274684 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 900 Bryn Mawr Ave | Penn Valley, PA 190721404 | 2155274684 |
| 24 Brighton Ln | Oak Brook, IL 605232324 | 2155274684 |
| Code | Practice | License No State |
|---|---|---|
| 208D00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Allopathic & Osteopathic Physicians General PracticeAccess to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians General Practice Allopathic & Osteopathic Physicians General Practice General Practice Primary Care/Family Planning/APRN/PA General Practice Allopathic & Osteopathic Physicians | 036-077958
IL |