Peter R. Kelly M.D. Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G29430 Issued in CA

Legal business name

PETER R. KELLY M.D. INC

Doing business as

Peter R. Kelly M.D.

Practice address

1224 10TH St Ste 205
Coronado, CA 92118-3420

Phone

(619) 435-0186

Fax

(619) 435-0594

NPI assigned

Mar 9, 2018

Last updated

Jun 16, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

PETER R. KELLY M.D.As reported in NPPES

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

Authorized official

Name

Karin Loni Spence

Title

Office Manager

Phone

(619) 435-0186

Specialties & licenses 1

Addresses

Other names 1

• PETER R. KELLY M.D. Doing business as

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

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1699278267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 10TH ST STE 205",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921183420",
            "telephone_number": "619-435-0186",
            "fax_number": "619-435-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 10TH ST STE 205",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921183420",
            "telephone_number": "619-435-0186",
            "fax_number": "619-435-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER R. KELLY M.D. INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PETER R. KELLY M.D.",
        "enumeration_date": "2018-03-09",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "SPENCE",
        "authorized_official_first_name": "KARIN",
        "authorized_official_middle_name": "LONI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "619-435-0186"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G29430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PETER R. KELLY M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah R Peck, COTA
• John Richard Pedrotty Jr., MD
• Gila Peled, LICENCED ACUPUNCTURE
• Charlie R Perez, PMHNP
• Stephanie Perez
• Deanna Sue Petersen, LCSW
• Laura Norton Petrovich, MD
• Michelle Pham, OD
• Alexander Phillips, DDS
• Kelsey Coria Phillips, DDS

• Internal Medicine Physician in Coronado, CA
• Providers in Coronado, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.