Provider Type Icon

MARTIN J. KELLY PA NPI 1447300702


NPI Information

NPI: 1447300702
Provider Name: MARTIN J. KELLY, PA
Classification: Physician Assistant - 363A00000X
Entity Type: Individual
Organization: HARTFORD HEALTHCARE URGENT CARE CENTERS LLC

PECOS Registration: Yes

Address:
263 FARMINGTON AVE
PROVIDER ENROLLMENT
FARMINGTON, CT
ZIP 06030
Phone: (860) 679-7503
Get Directions

Martin J. Kelly, PA is a physician assistant in Farmington, CT with 26 years of experience. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. Martin J. Kelly, PA NPI is 1447300702. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1998

The provider's business location address is:

263 FARMINGTON AVE
PROVIDER ENROLLMENT
FARMINGTON, CT
ZIP 06030-212
Phone: (860) 679-7503
Fax: (860) 679-1610

The NPI 1447300702 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/11/2007 and was last updated on 3/23/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363A00000XPhysician Assistant000979CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1000979OTHERCONNECTICUTPA LICENSE
2D00008699MEDICARE PINCONNECTICUT
3970002005MEDICARE ID-TYPE UNSPECIFIEDCONNECTICUTFOR CLINIC C00814
430656OTHERCONNECTICUTCONTROLLED SUBSTANCE LIC
5MK1183045OTHERFEDERAL DEA
6P70041MEDICARE UPINCONNECTICUT
7003009792MEDICAIDCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.