Healthcare Provider Details

I. General information

NPI: 1750745139
Provider Name (Legal Business Name): KELSEY ELIZABETH GOODMAN DONOHO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

2429 CALIFORNIA ST NW
WASHINGTON DC
20008-1615
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-3314
  • Fax:
Mailing address:
  • Phone: 949-370-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS7202
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA141077
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD210001304
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: