Active NPI
Mirle A Kellett, M.D.
- Interventional Cardiology Physician
- Scarborough, ME
National Provider Identifier
1023088218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Cardiology Physician
- License
- MD12317
- Practice address
- 96 Campus Dr
Suite 1
Scarborough, ME 04074-7133 - Phone
- (207) 396-5611
- NPI assigned
- Jan 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Cardiology Physician | 207RI0011X | MD12317 | ME | Primary |
Addresses
Primary practice location
96 Campus Dr
Suite 1
Scarborough, ME 04074-7133
Mailing address
301C US Route 1
Scarborough, ME 04074-9701
Phone (207) 396-8600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 282560099 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD12317 | ME | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Maine Multi-Medical Specialists | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416960000000",
"number": "1023088218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301C US ROUTE 1",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "040749701",
"telephone_number": "207-396-8600",
"fax_number": "207-396-8632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96 CAMPUS DR",
"address_2": "SUITE 1",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "040747133",
"telephone_number": "207-396-5611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLETT",
"first_name": "MIRLE",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2014-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "ME",
"license": "MD12317",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "282560099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scarborough, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.