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NPI Code Detail

MEDICARE: DR. KELLI B MAYFIELD MD

MEDICARE:  DR. KELLI B MAYFIELD  MD
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
1207QG0300XGeriatric Medicine (Family Medicine) Physician309109-01NY
2207QG0300XGeriatric Medicine (Family Medicine) Physician010127185VA
3207QG0300XGeriatric Medicine (Family Medicine) Physician018447ME
4207QG0300XGeriatric Medicine (Family Medicine) PhysicianTD091103ME
5207QG0300XGeriatric Medicine (Family Medicine) Physician9500998NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598743114
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLI B MAYFIELD MD
Provider Business Mailing Address
First Line : 819 FOREST AVE
Second Line :
City : ORONO
State : ME
Zip : 04473-3013
Country : US
Telephone Number : 207-217-4275
Fax Number :
Provider Business Practice Location Address
First Line : 101 CABARRUS AVE E
Second Line :
City : CONCORD
State : NC
Zip : 28025-3699
Country : US
Telephone Number : 980-960-2563
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 10/06/2021

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Directions to “ DR. KELLI B MAYFIELD MD” Practice Location

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