IndividualActive
Blaze Kelly, DO
NPI 1003445842 · Pain Medicine (Anesthesiology) Physician · Bridgeport, CT
Provider details
- NPI number
- 1003445842
- Entity type
- Individual
- Primary specialty
- Pain Medicine (Anesthesiology) PhysicianAllopathic & Osteopathic Physicians
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- License
- OT019937 (PA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Student, Health Care
Practice location
267 Grant St
Bridgeport, CT 06610-2805
Phone: (203) 384-3000
Fax: (203) 384-4108
Approximate (ZIP-level) locationGet directions
Mailing address
111 S 11th St Ste 8290
Philadelphia, PA 19107-4824
Additional practice locations (1)
- 111 S 11th St Ste 8290Philadelphia, PA 19107-4824Phone: (215) 955-2370Fax: (215) 955-0677
Registry dates
- Enumerated
- 2020-04-03
- Last updated
- 2025-05-16
- Certified
- 2025-05-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.