Provider Demographics
NPI:1043654007
Name:KELTY, JASON (DPM)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KELTY
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:3733 PARK EAST DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4338
Mailing Address - Country:US
Mailing Address - Phone:216-672-4330
Mailing Address - Fax:866-571-4884
Practice Address - Street 1:116 EAST AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2300
Practice Address - Country:US
Practice Address - Phone:216-245-1290
Practice Address - Fax:866-571-4884
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2016-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH36003762213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist