Provider Demographics
NPI:1033233192
Name:KELLY, BRENDAN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:PATRICK
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:22 DEL PRADO ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1312
Mailing Address - Country:US
Mailing Address - Phone:503-305-6577
Mailing Address - Fax:503-305-6577
Practice Address - Street 1:3377 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:541-222-8500
Practice Address - Fax:541-222-6435
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD600953702080P0202X
ORMD293082080P0202X
MI4301080000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics