Kelly, Martin J.
Kelly, Martin J. is an individual health care provider with primary practice located at 263 Farmington Ave Provider Enrollment, Farmington CT 06030-2212. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Kelly, Martin J. can be contacted via phone (860) 679-7503.Contact Information
Primary practice address
263 Farmington Ave Provider Enrollment
Farmington CT 06030-2212
Phone: (860) 679-7503
Fax: (860) 679-1610
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 000979 | Connecticut |
Profile Details
| NPI number | 1447300702 |
|---|---|
| LBN Legal business name | Kelly, Martin J. |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 11th, 2007 |
| Last updated | Mar 7th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447300702 | NPPES |
| Connecticut | MEDICAID | 003009792 | |
| Connecticut | Other | 30656 | |
| Connecticut | Other | 000979 |
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