Provider Demographics
NPI:1548228166
Name:KELTY, PATRICK JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:KELTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 MILL ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1601 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-2107
Practice Address - Country:US
Practice Address - Phone:508-678-0004
Practice Address - Fax:508-678-6970
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA246352208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088641AMedicaid
RI7006685Medicaid
MA002124602Medicare PIN
RI0322310001Medicare NSC
RI10057OtherNEIGHBORHOOD HEALTH PLAN
RI797515OtherTUFTS
RI0007006685Medicare ID - Type Unspecified
RI403135OtherBLUE CHIP
RI6890345OtherCIGNA
MA000685301Medicare PIN
RIAA51691OtherHARVARD PILGRIM HEALTH CA
RI1900216OtherUNITED HEALTH CARE
RI340018154OtherRAILROAD MEDICARE