Healthcare Provider Details

I. General information

NPI: 1649703273
Provider Name (Legal Business Name): KEALAN HOBELMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 PRINCE PHILIP DR STE 224
OLNEY MD
20832-1504
US

IV. Provider business mailing address

18111 PRINCE PHILIP DR STE 224
OLNEY MD
20832-1504
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-0074
  • Fax: 301-774-0640
Mailing address:
  • Phone: 301-774-0074
  • Fax: 301-774-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0093794
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: