Healthcare Provider Details

I. General information

NPI: 1255793980
Provider Name (Legal Business Name): KELLI BALDWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

1 INVENTA PLACE 5TH FLOOR SUITE HC05-01B, G507
SILVER SPRING MD
20910
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-4447
  • Fax:
Mailing address:
  • Phone: 301-565-4258
  • Fax: 301-244-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD210001458
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: