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Lawrence Bennett Kelly, MD
Specialist in South Charleston, West Virginia
NPI 1629031901

Lawrence Bennett Kelly is a Specialist based in Charleston, WV. Lawrence Bennett Kelly practices in South Charleston, WV and has the professional credentials of MD. The NPI Number for Lawrence Bennett Kelly is 1629031901 and holds a License No. 12306 (West Virginia).

The current practice location address for Lawrence Bennett Kelly is 4825 Maccorkle Ave Sw Ste C, South Charleston, WV and can be reached out via phone at 304-343-1022 and via fax at 304-343-1025.

Location: 4825 Maccorkle Ave Sw Ste C, South Charleston, WV, 25339-1850
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1629031901
Provider Name
Lawrence Bennett Kelly
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
4825 Maccorkle Ave Sw Ste C, South Charleston, WV, 25339-1850
Phone Number
304-343-1022
Fax Number
304-343-1025
Provider Enumeration Date
04/08/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
001720795 01 WV BLUE CROSS BLUE SHIELD
0114543001 05 WV
260047649 01 WV MEDICARE RAILROAD
institution
Provider Business Practice Location Address Details
Address
4825 Maccorkle Ave Sw Ste C
City
South Charleston
State
West Virginia
Zip
25309-1365
Phone Number
304-343-1022
Fax Number
304-343-1025
person
Provider Business Mailing Address Details
Address
4825 Maccorkle Ave Sw Ste C
City
South Charleston
State
West Virginia
Zip
25309-1365
Phone Number
304-343-1022
Fax Number
304-343-1025
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
12306 (West Virginia)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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