MEDICARE: DR. KELSEY ADAIR WELLMAN AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist

General Provider Information

NPI Number	:	1386242972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELSEY ADAIR WELLMAN AU.D.

Provider Business Mailing Address
First Line	:	802 LANDMARK DR STE 119
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-9121
Country	:	US
Telephone Number	:	410-760-8840
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 LANDMARK DR
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-9100
Country	:	US
Telephone Number	:	410-760-8840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	10/14/2021

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