Healthcare Provider Details

I. General information

NPI: 1942573324
Provider Name (Legal Business Name): KELLY ANN THOMAS CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 ALVIN AVE
BALTIMORE MD
21228-4731
US

IV. Provider business mailing address

2203 ALVIN AVE
BALTIMORE MD
21228
US

V. Phone/Fax

Practice location:
  • Phone: 443-904-4774
  • Fax:
Mailing address:
  • Phone: 443-904-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: