Healthcare Provider Details

I. General information

NPI: 1992286736
Provider Name (Legal Business Name): KALLIE M SELLERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

8600 MCDONOGH RD
OWINGS MILLS MD
21117-1009
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7410
  • Fax: 443-777-7558
Mailing address:
  • Phone: 240-818-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: