Basic Information
| Provider Information | |||||||||
| NPI: | 1114192226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLEY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060308082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606798080 | ||||||||
| FaxNumber: | 8606791430 | ||||||||
| Practice Location | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060304319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606798080 | ||||||||
| FaxNumber: | 8606791430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | MD454095 | PA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 070803 | CT | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.