Provider Demographics
NPI:1871564591
Name:KELLY A. PALUMBO M.D. P.C.
Entity type:Organization
Organization Name:KELLY A. PALUMBO M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-654-3222
Mailing Address - Street 1:219 W FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1909
Mailing Address - Country:US
Mailing Address - Phone:724-654-3222
Mailing Address - Fax:724-654-9140
Practice Address - Street 1:219 W FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1909
Practice Address - Country:US
Practice Address - Phone:724-654-3222
Practice Address - Fax:724-654-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068307L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012729200001Medicaid
PAG96035Medicare UPIN
PA1012729200001Medicaid