Healthcare Provider Details

I. General information

NPI: 1023075538
Provider Name (Legal Business Name): MICHAEL HOWARD KELEMEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 KNOLL NORTH DR SUITE 200B
COLUMBIA MD
21045-2300
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-5303
  • Fax:
Mailing address:
  • Phone: 410-933-2704
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD18047
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD18047
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: