Provider Demographics
NPI:1548823982
Name:ADILETTA, KELLEY GERMAN (MD)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:GERMAN
Last Name:ADILETTA
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 1:201 N 8TH ST UNIT 611
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1015
Mailing Address - Country:US
Mailing Address - Phone:412-759-2093
Mailing Address - Fax:
Practice Address - Street 1:1001 BALTIMORE PIKE STE 208
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2852
Practice Address - Country:US
Practice Address - Phone:610-604-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD474557208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program