Provider Information for 1114192226
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Mr. BRIAN JOSEPH KELLEY M.D.
Sex: Male
NPI: 1114192226
Last Updated: 2023-01-17
Certification Date: 2023-01-17
Certification Date: 2023-01-17
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1114192226 | ||||||||||||||
| Enumeration Date | 2008-04-29 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-8082 United States Phone: 860-679-8080 | Fax:860-679-1430 | ||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-4319 United States Phone: 860-679-8080 | Fax:860-679-1430 | ||||||||||||||
| Secondary Practice Address(es) | 3401 CIVIC CENTER BLVD 65 KANE STREET | ||||||||||||||
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