Provider Demographics
NPI:1679546444
Name:KELLY, KAREN MAUREEN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MAUREEN
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5400
Mailing Address - Country:US
Mailing Address - Phone:302-994-8887
Mailing Address - Fax:302-994-8208
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-994-8887
Practice Address - Fax:302-994-8208
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0004329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000562301Medicaid
DEG53804Medicare UPIN
DE0000562301Medicaid