Michael J. Kelly MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

041727 Issued in CT

Legal business name

MICHAEL J. KELLY MD

Practice address

308 Main St
Lakeville, CT 06039-1204

Phone

(860) 435-3551

Fax

(860) 435-3561

NPI assigned

Jun 10, 2008

Organization subpart

No

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

Authorized official

Name

Michael J Kelly, MDNPI 1124102546

Title

Owner

Phone

(860) 435-3551

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael J Kelly, M.D.

  • Internal Medicine Physician
  • Salisbury, CT
  • NPI 1124102546
  NPD (past) Authorized official
• Randall R Dwenger, MD

  • Psychiatry Physician
  • Canaan, CT
  • NPI 1649291980
  NPD (past)

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1376703751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1748",
            "city": "LAKEVILLE",
            "state": "CT",
            "postal_code": "060391748",
            "telephone_number": "860-435-3551",
            "fax_number": "860-435-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 MAIN ST",
            "city": "LAKEVILLE",
            "state": "CT",
            "postal_code": "060391204",
            "telephone_number": "860-435-3551",
            "fax_number": "860-435-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J. KELLY MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-435-3551",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "041727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001417270",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1124102546",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Leimbach, ATC
• Lime Rock Park, LLC
• Marietta Whittlesey LPC LLC
• Marjorie a. Arni LLC
• David Arthur McArthur, MSW
• Caroline R Newton, M.D.
• Charles Parker Newton, CMHC, LPC, NCC
• Northwest Center for Family Service and Mental Health, Inc.
• Richard O'Connor, MSW, PH.D.
• Janet Prindle, LCSW

• Internal Medicine Physician in Lakeville, CT
• Providers in Lakeville, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; 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.