Provider Demographics
NPI:1770902421
Name:KELLEY, JAMES FITZHUGH (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FITZHUGH
Last Name:KELLEY
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 1:1001 S GEORGE STREET
Mailing Address - Street 2:BLDG MKB
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3676
Mailing Address - Country:US
Mailing Address - Phone:717-851-2521
Mailing Address - Fax:717-851-3535
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:BLDG MKB
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2521
Practice Address - Fax:717-851-3535
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT206116207Q00000X
390200000X
PAMD460976207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program