Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Blaze Kelly, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1003445842

Dr. Blaze Kelly, DO is a Pain Management in Bridgeport, Connecticut. Graduated from Lake Erie College of Osteopathic Medicine, Erie in 2020, 6 years ago. Practices with Yale University, a 2,618-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Connecticut and Pennsylvania.

Years since qualifying
6
Trained at
Lake Erie College of Osteopathic Medicine, Erie
Licensed in
CT, PA
In the registry since
2020
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Practice location Address checks out

267 Grant St
Bridgeport, CT 06610-2805
Phone: (203) 384-3000
Fax: (203) 384-4108
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 — (215) 955-2370

Specialties & licences

Pain Medicine (Anesthesiology) Physician (primary) Taxonomy 207LP2900X · Licence 81122 (CT)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence OT019937 (PA)

Record details

NPI number1003445842
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 3, 2020
Last updated in NPPESMay 16, 2025
Certification dateMay 16, 2025
Mailing address111 S 11th St Ste 8290, Philadelphia, PA 19107-4824

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPAIN MANAGEMENT
Also practisesANESTHESIOLOGY
Medical schoolLAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE, ERIE
Graduated 2020 (6 years in practice)
Group practice Yale University — 2618 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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