Kelly Ann Dzialo, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD452160 Issued in PA

Practice address

1233 Locust St
Suite 400
Philadelphia, PA 19107-5453

Phone

(215) 545-8188

Fax

(215) 545-8446

NPI assigned

May 20, 2008

Last updated

Aug 12, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kelly.dzialo@advocaredoctors.eclinicaldirectplus.com

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.

• Advocare , LLC

  dba Advocare Heritage Family Medicine

  • Family Medicine Physician
  • Moorestown, NJ
  • NPI 1053589515
  NPD (past)

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1407013246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 LOCUST ST",
            "address_2": "SUITE 400",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075453",
            "telephone_number": "215-545-8188",
            "fax_number": "215-545-8446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 LOCUST ST",
            "address_2": "SUITE 400",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075453",
            "telephone_number": "215-545-8188",
            "fax_number": "215-545-8446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZIALO",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-20",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA08740500",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD452160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dynasty Home Care LLC
• Kevin C. Dysart, MD
• Faith Val Dyson-Washington, PH.D.
• Oleg Dyutin, M.D.
• Larisa Surenovna Dzhavakova, M.D.
• Matthew Dziama, PA-C
• Emily Dziedowiec
• Halina Dziewolska, LBS
• Suleiman M Dzilala II, DMD
• Julia Dziubinski, DO

• Pediatrics Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.