Provider Demographics
NPI:1548297930
Name:KELLY, PAUL F (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN ST.
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1253
Mailing Address - Country:US
Mailing Address - Phone:203-709-6000
Mailing Address - Fax:
Practice Address - Street 1:56 FRANKLIN ST.
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1253
Practice Address - Country:US
Practice Address - Phone:203-709-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035359207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT035359OtherCONNECTICARE
CTP407727OtherOXFORD HEALTH PLANS
CT10-86502OtherUHC
CT4369921OtherAETNA HEALTH PLANS
CT01035359OtherCIGNA HEALTH PLANS
CT0R03179OtherHEALTH NET OF NORTHEAST
CT206706OtherWELLCARE
CT604583OtherUNITED HEALTHCARE
CTP00025411OtherRR MEDICARE
CO010035359CT01OtherANTHEM BC & BS
CT873719OtherUSA
CT001353599Medicaid
CT873719OtherUSA
CTP407727OtherOXFORD HEALTH PLANS
CO010035359CT01OtherANTHEM BC & BS