Provider Demographics
NPI:1245529460
Name:KELLY, ERIN TERESA (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:TERESA
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 HAVERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1361
Mailing Address - Country:US
Mailing Address - Phone:215-685-7600
Mailing Address - Fax:215-685-7379
Practice Address - Street 1:4400 HAVERFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1361
Practice Address - Country:US
Practice Address - Phone:215-685-7600
Practice Address - Fax:215-685-7379
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454541207R00000X, 208000000X
NY267758-1207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics