NPI 1003445842

Blaze Kelly, DO

Practitioner Pain Medicine (Anesthesiology) Physician Bridgeport, CT

Practice location

Address: 267 Grant St, Bridgeport, CT 06610-2805
Phone: (203) 384-3000
Fax: (203) 384-4108
Mailing address: 111 S 11th St STE 8290, Philadelphia, PA 19107-4824

Registered specialties (2)

Pain Medicine (Anesthesiology) Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207LP2900X Licence 81122 (CT)

Other Anesthesiology providers in Connecticut →

Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X Licence OT019937 (PA)

Other Student in an Organized Health Care Education/Training Program providers in Connecticut →

Registry record

NPI: 1003445842
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Apr 2020
Record last updated: 16 May 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.