Richard H Kelty, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

G39396 Issued in CA

Practice address

215 W Janss Rd
Pathology Dept
Thousand Oaks, CA 91360

Phone

(805) 373-8582

Fax

(805) 373-6865

NPI assigned

Feb 28, 2006

Last updated

Sep 21, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Glover Kelty and Schultheis M DS

  • Anatomic Pathology & Clinical Pathology Physician
  • Thousand Oaks, CA
  • NPI 1245263243
  NPD (past)
• Thousand Oaks Pathology Associates Inc a Medical Group

  dba Thousand Oaks Pathology Associates Inc

  • Clinical Medical Laboratory
  • Thousand Oaks, CA
  • NPI 1912930900
  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316563200000",
    "number": "1154397164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2190 LYNN RD",
            "address_2": "STE 220",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "91360",
            "telephone_number": "805-495-8050",
            "fax_number": "805-496-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W JANSS RD",
            "address_2": "PATHOLOGY DEPT",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "91360",
            "telephone_number": "805-373-8582",
            "fax_number": "805-373-6865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELTY",
        "first_name": "RICHARD",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2011-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "G39396",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NM",
            "license": "84203",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOG393960",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Kelley, M.D.
• Shayne Thomas Kelley
• Skye Kellingsworth
• Anna Rachel Kelner
• Mary Kelso, PH.D.
• Kelvin Loh, MD. Facs.
• Robert G Kemmerling, PH.D
• Samantha Taylor Kennedy
• Kenneth L Saul MD, Inc. (North Oaks Pediatric Medical Associates)
• Kensington Physical Therapy

• Anatomic Pathology & Clinical Pathology Physician in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Anatomic Pathology & Clinical Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; 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.