NPIMap

Organization Active NPI

Maureen P Kelly MD PC

  • Specialist
  • Philadelphia, PA
National Provider Identifier
1134439037
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD047210L Issued in PA
Legal business name
MAUREEN P KELLY MD PC
Practice address
822 Pine St
Suite 4B
Philadelphia, PA 19107-6187
Phone
(215) 829-8110
Fax
(215) 829-8119
NPI assigned
Oct 14, 2010
Last updated
Apr 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Maureen P Kelly, M.D.
Title
President/Medical Director
Phone
(215) 829-8110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD047210L PA Primary

Addresses

Primary practice location

822 Pine St
Suite 4B
Philadelphia, PA 19107-6187

Mailing address

822 Pine St
Suite 4B
Philadelphia, PA 19107-6187
Phone (215) 829-8110

National Provider Directory

National Provider Directory

Locations

822 Pine St
Ste 4B
Philadelphia, PA 19107
Phone (215) 829-5757

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1134439037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 PINE ST",
            "address_2": "SUITE 4B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076187",
            "telephone_number": "215-829-8110",
            "fax_number": "215-829-8119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 PINE ST",
            "address_2": "SUITE 4B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076187",
            "telephone_number": "215-829-8110",
            "fax_number": "215-829-8119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAUREEN P KELLY MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-14",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "215-829-8110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD047210L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.